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Experiential Learning

Experiential Learning involves either experiencing or doing something, followed by reflection on this activity and coming to a new understanding as a result. It encompasses both the “experience” and the subsequent analysis and integration of this new knowledge. The learning is unique to each learner, as each individual experiences activities differently. As illustrated by the image below, traditional lecture style teaching allows minimal retention of knowledge, but participating and learning by doing are significantly more effective methods. Experiential learning can occur in the classroom through hands-on activities, role-playing, games, group work, etc.. It can also occur in the field through practicums, apprenticeships, volunteer work and field trips.

Taken from Wikipedia’s “Experiential Learning”

When discussing experiential learning, many refer to Kolb (1984) who described the Experiential Learning Cycle. In this theory, learning is thought to progress through four stages: concrete experience (new learning experience), reflective observation (reflection on new experience related to current understanding), abstract conceptualization (new ideas of understanding occur) and active experimentation (applying and testing new knowledge).  Each of these stages builds from the others and is necessary for real learning to occur.

learning cycle
From  http://www.simply psychology.org/learning-kolb.html

What are the implications for my teaching?

In my own field, much of the learning is experiential as nursing is by nature very practical and hands-on. Students in a nursing program use simulations and hands-on activities to practice skills, like wound care and catheterization. Students rotate through many practicums on various floors of the hospital and have several apprenticeships where they are paired with a registered nurse. As a clinical nursing instructor, the experiences are already presented to the learners, so it is my job to support the reflection, conceptualization and testing processes associated with them.

The article Best Practices in Experiential Learning describes the instructor as a resource, cheerleader and facilitator in these situations. This article outlines experiential learning methods in depth, but some highlights include:

  • creating a safe space free of judgement and establishing rapport with students
  • encouraging the bigger perspective
  • getting students to examine their own values
  • encouraging reflection
  • allowing students to safely step outside their comfort zones
  • matching students with meaningful and useful experiences
  • providing clear expectations
  • linking various concepts together
  • encouraging sharing with peers

Some examples in my own work as an instructor would be debriefing in post-conference to discuss issues encountered during the day, encouraging deeper journaling and posing questions to encourage analysis of what was experienced.

 

References

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.

Merriam, L. and Bierema, S. (2013). Adult learning: linking theory and practice. San Francisco: Jossey-Bass.

Memory and Learning

Memory is an important consideration in teaching and learning. I enjoyed reading this summary of the book Make It Stick by Brown, Roediger and McDaniel, which explores scientific evidence for deeper learning related to memory. It seems many of the generally used methods to study and remember concepts are ineffective. Often students will try to use rote memory techniques or highlighting text, which do not lead to long-term retention. Some of the concepts gleaned from the summary include:

  • Deeper learning requires an effort to make it stick, so keep learning active
  • Interleaving concepts is helpful, i.e. meshing concept A with B, then C with A and B with C
  • Just when ideas are becoming understood switch topics to keep things varied
  • Frequently return to previous topics
  • Use reflective learning
  • Explain how learning works and model its process for learners
  • Help learners practice figuring out what they don’t know

In my own teaching practice, I would like to include all of the above. Of high importance would be modelling the learning process, as nurses are expected to be responsible for their own learning. It is impossible to know everything in healthcare, so when I myself don’t know the answer to a question I could walk them through the resources I use.

Another consideration for instructors is exploring how memory changes as people age. An article by the American Psychology Association says that the brain does change as people get older and so does memory. Noticeable memory decline often begins when people are in their 40s, as there are less neuron connections and blood flow to the brain. However, though people start to have trouble remembering what they ate for breakfast or specific episodes, other types of memory, such as words and concepts or procedures, remain intact. The article explains that research shows people can compensate for memory difficulties. In fact, memory training classes can measurably enhance memory retention throughout the lifespan.

As an instructor, it is important not to discount people as they age. It is also very helpful to explicitly explain how memory and learning works, as these skills can boost learning at any age. Older learners can also bring more knowledge and experience than younger counterparts.

 

Motivating Adult Learners

Motivating adult learners requires careful thought and planning. John Keller devised the ARCS Model of Motivational Design, which takes into account the characteristics of adult learners. Two articles by E-Learning Industry and Poulsen, Lam, Cisneros and Trust outline the components of ARCS, as well as practical applications for instructors. The acronym ARCS stands for the four areas of Attention, Relevance, Confidence and Satisfaction that are expanded below:

Attention:

Learners are motivated when their interest is piqued in the areas of perceptual arousal (surprise and uncertainty), inquiry arousal (challenges and problems to solve) and variability (variety). Some teaching methods to grab attention in these areas include:

  • using a variety of media, teaching methods and presentation styles
  • incorporating humour
  • presenting conflicting opinions that can be discussed
  • stimulating critical thinking with interesting questions
  • using real-life examples that learners may relate to
  • using active learning activities (hands-on learning, role-playing, etc.)

Relevance:

Learners are motivated when they can relate to the topics and are familiar with the language used. Keller used the techniques of motive matching (student reasons for taking course), familiarity (building on learners’ own knowledge and experience) and goal-orientation (how the course is useful) to establish relevance. Instructional strategies using these include:

  • Explain how skills or knowledge will help learners in the present as well as in the future
  • Draw connections between learners’ existing knowledge and the course content
  • Bring in an expert or role model related to the content
  • Explore the reasons each learner is taking the course and teach to these goals
  • Let the learners choose what they explore and the instructional strategies that are used

Confidence:

Learners that believe they will succeed are more motivated. This can be achieved by giving learners more control, clearly communicating objectives and giving feedback. Some examples of this are:

  • At the start of the course, clearly outline the evaluation criteria and what is needed for success
  • Give lots of positive and constructive feedback
  • Create opportunities for learners to be successful
  • Allow learners control over some of the learning activities
  • Nurture self-growth with small steps and visible progress

Satisfaction:

Learners are motivated if they get a sense of satisfaction from rewards and reinforcement. Rewards can be intrinsic (from within the learner) or extrinsic (from the instructor or classmates). Some methods to incorporate this are:

  • Provide opportunities to apply new knowledge and skills
  • Give praise and rewards
  • Give positive feedback
  • Make sure standards are consistent throughout the course

How will this impact my own teaching?

There are several things from the ARCS model that I would like to incorporate into my own teaching. To grab learners’ attention, I believe in using a variety of activities and teaching methods to keep things interesting. As a clinical instructor, this would involve group discussions, videos, demonstrations, as well as more traditional power points on occasion. As nursing education is very practical by nature, real-life examples of clinical issues and hands-on practice with patients are naturally part of the instruction. I like the idea of using conflicting viewpoints to stimulate interest, such as discussing the controversial issue over whether a client should get a feeding tube or not. To keep the learning active on a potentially dry topic such as wound care, I would use hands-on games with wound care products and pictures of various wounds.

To make the instruction relevant, I would get to know the specific nursing area that each student is interested in. Then, I could pair them with a ride-along nurse for that specific area, who might serve as a role model. I would give a choice of options for an assignment based on this interest, such as choosing between palliative care or chronic disease management for an essay. Another way to make things relevant is to explain the importance of paying attention to certain information, such as the possible consequences to the patient when medication is given incorrectly.

In order to instil confidence and satisfaction, I would clearly outline at the start of the term what is required for success. When evaluating a skill, I would give them a skills checklist ahead of time, so they know each step that is necessary. Positive and frequent constructive feedback is important, such as telling a learner that they’ve really improved their time-management on the hospital ward. As it is important that nurses become comfortable being responsible for their own learning, I would encourage them to practice taking ownership of skills they need to practice more often. I could have each learner make up a list of skills they wish to work on during the clinical rotation.

 

Creating a Positive Learning Environment

Creating a positive learning environment first requires knowledge of the characteristics of adult learners and how they are different from children. This allows an atmosphere of respect to be cultivated, and allows a balance between learners feeling safe and challenged (see Bright Hub). This article by Susan Imel states that three components of a positive learning environment are trust, open communication and shared learning experiences. It outlines several helpful points:

  • Acknowledging that adult learners bring a wealth of knowledge and experience is important
  • Set the tone in the first few minutes of class about it being a safe and respectful space.
  • With the help of the learners, setting clear goals and expectations at the start is essential.
  • Group discussions and group work that allow people to share ideas are useful.
  • Feedback should be given respectfully and not in public.
  • Information and assignments should be relevant and interesting to the learners, allowing them to draw on previous knowledge.

TrainerHub adds a few other ideas for a positive learning environment:

  • Use a positive attitude
  • Teach topics that are interesting to you, as your passion will come through.
  • Focus on the learner. Get to know their strengths and weaknesses.
  • Use learning circles to build support and collaboration among learners.
  • Appeal to the senses through visuals, sounds, colour and hands-on experiences.

Below is a video with tips from experienced teachers on creating a positive learning environment:

Another tool that creates a positive classroom is humour. According to this article by Wazner, properly used humour creates a better relationship between the instructor and learner, allows for more effective learning, controls stress and also makes the learner happier. Students rate classes and teachers that use humour as more memorial and influential. However, this article also says that poorly used humour has a negative effect on learning. Poorly used humour includes jokes unrelated to the material, sexual jokes, jokes picking on a student, etc. This article also found that those to which humour does not come naturally should think twice about forcing humour into their instruction.

These ideas will influence my own teaching in several ways. Many of these ideas, such as setting the tone at the beginning  and creating a respectful space to learn, seem like methods I already use and probably have picked up on from previous positive learning environments. However, it is always beneficial to be reminded to purposefully include them. I like the idea of setting clear goals and expectations, as it always made me personally less anxious as a learner. In my own instruction, I will ask learners what their goals are and list them along side my own instructor goals at the beginning of class. I also appreciate the idea of collaborative learning and will try to include group work or discussion each day.

In terms of humour, I fell pressure to include more humour in my instruction, though this is not my natural talent. It is comforting to read the study that says it is better if I do not force humour and just use the natural (albeit infrequent) opportunities when the arise.

Skype Call with my Partner

Yesterday, Kerin and I had a skype call to discuss our blog posts so far (see kerinnurseblog). All of our posts seem to agree with each other. We first talked about trends in nursing, as we are both registered nurses. Kerin had two blog posts regarding the need for awareness around the multicultural nature of our patients and the effect of the nursing shortage on patient care. I agreed that in my own job as a community health nurse, I encounter the need for translators and cultural sensitivity daily. Both Kerin and I also see that there is a shortage of nurses and we are constantly being asked to do more with less. My own post regarding the push for less home visits from nurses highlighted this.

We then discussed the our posts about trends in adult education. Kerin’s post was about the trend towards learners collaborating . She saw this in her teaching position as an IV nurse educator and also in the trend of using online courses and technology to bring geographically apart learners together. We thought this worked well with my own post about MOOCs making education more accessible. Kerin expressed concern over online courses being difficult as there is minimal one-on-one interaction. We agreed that in nursing in particular, learning from immersion in the practical with colleagues and face to face learning is crucial. Kerin talked about how her nursing education in South Africa was very different from the training today. We discussed how there is too much emphasis on theory when more practical learning is needed for new nurses.

We also touched on the post about adult learners’ traits. We agreed that our entries were similar.

 

 

Characteristics of Adult Learners

Prior to this course, I would have pictured “learners” as children and the traits that come with them. However, an article on adult learners outlines the some characteristics that are different when considering adults instead of children. Many of these differences come from adults having gained more life experience and being at a different life stage than school-aged individuals. These listed traits are based on the assumptions and principles described by Knowles in his 1984 research on this topic and summarised by this website. These include a need for:

  •  autonomy and control in the learning process, as well as self-direction
  •  material to be goal-oriented and practical; holding clearly seen value for the learner
  • respect and to be treated as equal
  • learning to be active rather than passive
  • learning to be problem rather than subject oriented

As well, adult learners often:

  • bring a wealth of knowledge from which to draw in their learning
  • can have baggage from negative life experiences or rigid thinking that hold back learning
  • have responsibilities other than learning, such as jobs and children
  • are motivated from within to learn
  • come from varied experiences and backgrounds

These of course are generalizations that differ from person to person. This article also suggests that these traits are based on western educated learners and do not always apply across different cultures. It highlights that in some classrooms around the world, disagreements are not tolerated and learning is teacher-centered, which differs from the autonomy in western students. In some places, knowledge is communal and to be shared, unlike the western individualistic model. As well, in some cultures where women have lower status, they discouraged from speaking up as students.

A Tibetan language class at the Lhasa Experimental Primary School with a communist Chinese flag in the classroom
From the Examiner.com

I will keep these in mind when designing my future classroom. I will create a classroom atmosphere based on respect and it being learner-centred, rather than it being teacher-centred and full of hierarchy. This could be done by asking for examples from the learners’ experiences to use as problems to work through. Instead of giving answers, the class could break into groups and comes up with the answers from their own “inner textbooks”. I would attempt to facilitate groups coming up with their own answers, rather than giving information.

Another example would be to set up the learning experiences to be self-directed. I could get the students to set their own goals and complete a learning contract. Self-reflection would be part of the experience.

Retrieved from https://www.youtube.com/watch?v=K1OSh6vN-6E

 

 

 

 

Trends in Adult Education: MOOCs!

Recently, I have been noticing a lot about the MOOCs or Massive Open Online Courses as a trend in adult education. As the name aptly describes, these online courses are offered free  to the public by organisations on a massive scale. A quick search of the website MOOC List reveals over 20,000 completely free course on everything from Japanese architecture to rural nursing.

what_is_mooc
Retrieved from http://edtechreview.in/dictionary/198-what-is-a-mooc

These courses have great potential to change adult education as they broaden the number of people having access to learning. According to this article (Cobb, 2016), MOOCs allow organisations to spread their message and educational institutions to attract more learners. Anyone who has access to the internet and the time and will to complete the course can gain extra knowledge and skills. Amazingly, the US Government has launched MOOCs designed for refugees. The talk below highlights the potential for people to create their own low cost college degree:

However, there are some critics saying that after the initial excitement for MOOCs, interest has started to wane (Pappano, 2014). As proof she cites the completion rate is under 10% for people who sign up for a course.

Overall, though, I believe increasing access to education through online means is a positive trend that will continue and MOOCs have played an interesting role.

References

Cobb, J. (2016). 12 trends still disrupting the market for life-long learning and continuing education. Tagoras. Retrieved from http://www.tagoras.com/lifelong-learning-market-trends/

Massive Open Online Course. (2016). In Wikipedia. Retrieved June 30, 2016 , from https://en.wikipedia.org/wiki/Massive_open_online_course

MOOC List. (2016). Retrieved from https://www.mooc-list.com

Pappano, L. (2012). Year of the mooc. The New York Times.  Retrieved from http://www.nytimes.com/2012/11/04/education/edlife/massive-open-online-courses-are-multiplying-at-a-rapid-pace.htm

What is MOOC? (2013). Ed Tech Review. Retrieved from  http://edtechreview.in/dictionary/198-what-is-a-mooc

Reshef, S. (2014, March). An ultra-low-cost college degree . Retrieved from https://www.ted.com/talks/shai_reshef_a_tuition_free_college_degree?language=en

Trends in Community Health Nursing: Fewer Home Visits

Healthcare and nursing are ever-changing fields. Policy-makers and management continually refine health practices to provide better and more efficient care with limited resources (Underwood, 2010). A general healthcare trend is the move towards keeping people out of our overloaded hospitals and facilities, with the idea that “Home is Best” (Vancouver Coastal Health, 2013, para.1). As a Community Health Nurse, my role is to support people to stay at home by helping them manage chronic conditions, coordinate home supports and providing care for wounds and catheters. Paradoxically, in my field, I have noticed a trend towards fewer home visits, rather than the increase one might expect. Instead, there is a push to care for people through telephone contacts or clinic appointments.

From a government and upper management point of view, reducing home visits makes sense. As people are expected to stay at home, there are more people needing care from a limited number of community nurses. A study by VanDeVelde-Coke (2004)found that nurses seeing clients in the home takes 46.6% more time than in a clinic if one includes travel time and charting, thus making home visits inefficient. The same study found that clients were equally or even more satisfied with their care at a clinic. At my health unit, nurses can see 11 clients per day in the clinic or over the phone, compared to visiting three to six clients in the home. On occasions, clients tell me that a clinic visit is way more convenient as they do not need to wait at home for a nurse. Often my clients say they prefer telephone visits over home visits as it takes less time and is less disruptive to their schedule.

In practice, however, patient care can suffer when fewer home visits occur. A local news article (Lus, 2011, October 25) raised concerns that reducing nurse home visits to new mothers means that serious illness of both the mother and baby can be missed. This story also highlights that without home visits the opportunity for people to open up about health problems to someone they trust may be missed. Though the media has not picked up on it yet, in my own practice as a community health nurse for the elderly and general adult population, I am seeing a similar phenomenon occur with fewer home visits. When people are seen in the clinic or assessed on the telephone, it is difficult to see if they are coping well at home. The nurse cannot tell if the client has a home that never gets cleaned, medications strewn all over the kitchen or throw rugs that could be trip hazards scattered about. During a phone call, a nurse cannot visually assess whether a client has increasingly swollen legs. Clinic visits are often shorter than home visits, allowing for less thorough assessments in general. Though in theory clients are asked to come to the clinic only if it will not negatively affect their health, I have seen clients fall simply walking into the treatment room. In my opinion, having more actual nurses see clients in both the home and through clinic/phone visits would be ideal.

From https://dukeregionalhospital.files.wordpress.com/2014/03/falls-risk.jpg

In theory, the initiative to keep people at home and out of hospitals or facilities seems to be aided by the trend of community health nurses seeing more clients in the clinic or over the phone, allowing nurses to see more clients in general. Unfortunately, in practice it is more difficult to provide thorough and safe care to patients when fewer home visits occur. Perhaps a solution may be found in a balance between hiring more community health nurses to do home visits when needed and continuing with the attempt to seeing clients in other ways when it is deemed appropriate.

References

Lus, Steve. (2011, October 25). BC cuts back nursing visits to new moms. CBC News. Retrieved from  http://www.cbc.ca/news/canada/british-columbia/b-c-cuts-back-nurse-visits-to-new-moms-1.1100144

Underwood, Jane, (2010). Maximizing community health nursing capacity in canada: a research summary for decision makers.Canadian Health Services Research Foundation. Retrieved from http://www.cfhifcass.ca/Migrated/PDF/ResearchReports/11510_Reiss_report_en_FINAL.pdf

Vancouver Coastal Health. (February, 2013). Home is Best News. Retrieved from http://vchnews.vch.ca/wp-content/uploads/2013/02/HiB-Newsletter-Feb-2013.pdf

VanDeVelde-Coke, Susan. (2004). The effectiveness and efficiency of providing homecare visits in nursing clinics versus the traditional home setting. Canadian Health Services Research Foundation. Retrieved from  http://www.cfhifcass.ca/Migrated/PDF/ResearchReports/OGC/coke_final.pdf