Applying aspects of educational psychology to the practice of nurse teaching

Christopher J Goodall

One of the many facets of educational psychology to which the nurse teacher should give consideration is the nature of human knowledge. An individual

I . interacting with his environment forms ideas or concepts which coalesce to create a

mental orcanisation, or ‘conceptual framework’, that is unique to that individual.

‘rhe nurse-teacher takes accouht of this uniqueness of such $ framework by assessing

the conceptual position occupied by each of his learners, and by adapting his

teaching strategies accordingly. Failure to do this can result in the inadequate learning of new ideas or concepts, in particular complex concepts such as arc found

in nursing. With reference to certain of the literature it is shown that the direct teaching of concepts does not occur, while the effectiveness of active learner

participation is demonstrated as aiding the ‘personalisation’ of newly ofrered

concepts, which then become truly part of the learner’s conceptual framework.

INTRODUCTION

In this article I hope to show how certain

aspects of the educational psychology com-

ponent of my nurse tutor course can be of

value to the practice of teaching, in the ‘real

world’ of the ward or classroom. To do this, I

have concentrated on the conceptual nature of

human knowledge and, consequently, ways in

which the teacher might approach the prob-

lems of concept learning. By developing an

awareness of‘ the ways in which we learn

1,especially those ideas which are new to us)

and by appiying this awareness critically to our

own teaching, tutors may formulate education-

ally sound methods of facilitating learning. A

grasp of the conceptual nature of human know-

ledge is of relevance not only to the individual

C J Goodall PhD RGN DN Cert Ed, Nurse Tutor York District School of Nursing, York Y03 7HE

,

teacher’s style of‘ presentation. or ttr a parti-

cular lesson plan, but also to the d(avising of an

entire curriculum to encompass a logical un-

folding of new ideas to an attc‘ntivc‘, interested

and participating class.

THE LEARNING OF CONCEPTS

Each new learner, on entering nursing, brings

into her training her internalisrd organisation

of the world as she has so far experienced it. an

organisation that includes her l-alur and atti-

tudes as well as more cognitive structures.

Individual concepts -join and overlap to create

this organisation, or ‘conceptual framework’.

These concepts are formed. in part, hv a

person attempting to make sense of’ his en\.iron-

ment Land perhaps also by exposition ;I p4)int

debated later) by relating that which he now

perceives to that which, identical. similar, or

diKerent, has been esperirnccd beti)rc~.

264 NURSE EDUCATION TODAY

While the ‘knowledge’ with which an indivi-

dual is born is innate, of a reflex nature (such

as sucking and gripping), conceptual know-

ledge is learned through interaction with his

environment, including its language compo-

nent. These concepts are not learned in isola-

tion as discrete items, but rather are ‘placed’

in the individual’s existing organisation of ideas

so that they relate to the knowledge structures

already there (Cohen 1977), thus creating sense

out of an otherwise bewilderingly complex

environment.

How does this ‘placing’ occur? How is it that

something new to be learned becomes part of a

person’s conceptual framework? According to

Piaget, it is this adaptation to new stimuli

which signals the individual’s intelligence

(McNally 1977, Child 1981). When something

new is perceived in the environment, when

there is a new experience, this can be adapted

to existing concepts (a process Piaget called

assimilation). Or, the individual’s current

ideas, or schemata, can be changed to cope

with these new stimuli (accommodation). It

may be seen that these two functions go hand

in hand, that accommodation tends to include

a certain amount of assimilation and vice

versa.

Piaget’s theory of the stages of development,

covering the years from birth to the age of

about 18, is not without its critics, in particular

regarding the nature of those stages and the

inevitability or not of the sequence in which

they occur, as well as the varying influences of

maturation, experience and language (Cohen

1977). Vigotsky (1962) stressed, for example,

how language changes man’s environment,

man’s adaptation to it and the nature of man’s

learning process itself. Language permits us not

only to communicate but to meditate: not just

to accept or transmit knowledge but to deepen

our understanding of it. The relationship be-

tween language and thought is complex, but of

great relevance to the teacher is Vigotsky’s

warning of the danger of the formation of

‘pseudo-concepts’ (pp 66-9, 75-7). A teaching

method that simply relates a series of ‘facts’ to

the child or adult ‘accomplishes nothing but

empty verbalism . . simulating a knowledge of

the corresponding concepts but actually cover-

ing up a vacuum’ (p 83) (Vigotsky 1962).

The danger here is that, rather than as-

similating a concept (particularly a complex

concept) or accommodating to it, a learner

changes that concept so as to match those of

his existing ideas which approximate to it, but

to the extent that its very nature is altered. It

is no longer the same concept, its essential core

remaining hidden and unlearned.

How can this danger be avoided? One

answer the teacher may adopt is the en-

couragement of active student participation in

the attainment of new concepts, an idea

stressed by Piaget (Schwebel & Raph, 1973)

and supported by Cohen (1977) and Ausubel

( 1978). Ausubel, indeed, suggested that the

more active the process is, the more meaningful

the assimilated concept is to its learner.

Teachers may regard this proposition as im-

portant to the effectiveness of their practice in

both ward and classroom.

NURSE TEACHING AND CONCEPT LEARNING

With the views of Ausubel and Cohen in mind,

we may well agree with Stones (1966), who

wrote: ‘The direct teaching of concepts does

not work.’ He was implying perhaps that a

ready formed (and therefore ‘personalised’)

concept cannot be lifted from the teacher’s

mind and transplanted into that of the learner,

however attentive. The learner, under the

skilled guidance of the teacher, forms her own

concept. (If Stones’ statement is true, it may be

wondered if anything - even a single, uncom-

plicated fact - can be taught; or whether

something can only be learned. If this is so,

what is the teacher’s role; what actually is

teaching? If ‘something’ is learned as a result of

another’s actions - speech or demonstration -

then may it not follow that ‘something’ has

been taught?)

How might it be judged that successful

learning has occurred? Cohen (1977) suggested

that a concept is learned when it is readily

understood, when it corresponds closely to that

of the teacher and when it is well retained.

Evaluation seems to be the key here, and also

the major challenge. The teacher must ensure

that the concept has truly been assimilated, not

just its name or the listing of a few of its

attributes. Thus a nurse may be sufficiently

adrpt at examination technique to include re-

ference to ‘community care’ in her paper, and

to receive credit for it, without a real under-

standing of the meaning and implications of

that subject. Therefore, when teaching, a cer-

tain amount of repetition or, better, a restating

01 the taught concept in diff‘erent ways (‘look-

ing‘ at it from various directions) are tech-

niques which are seen to increase learning.

E\,aluation of such learning may take the form

ot’ the learner stating the taught idea or con-

ccpt back to the teacher in her own words.

Si~ch techniques need to be consciously built

into both individual lessons and entire courses.

Creators of curricula may see in this revisiting

of’ a sttbject support for the idea of a ‘spiral’

t~rirriculum.

‘l‘omlinson I 1981) has written of three fur-

ther conditions for effective learning of con-

CYPCS: attention to relevant material by the

I~~xner; a restriction on the number of elements

a I1 d relationships in the lesson so as not to

exceed the learner’s short-term memory capa-

( ity: and the owning of ‘personalised’ constructs

which aid comprehension of newly presented

I)rtt related material. Here are three clear

guidelines for the nurse teacher in the planning

and deliver!; of‘ lessons: relevance (which helps

tc, maintain learner interest); conciseness and

c.larity I not overloading the learner with in-

f~~rmation); and starting at the conceptual

position occupied by each learner. a position

which needs to be discovered by preliminary

axsrssment. L On relevance, Postman and Weingartner

1971 expressed strong views, asserting that

rcachcrs cannot expect learners to pursue topics

of‘ study that hold no interest for them. L\

1~roblrm here is that a subject a nurse teacher

perceives as relevant may not be so regarded

11) his learners. Postman and Weingartner

appeared willing to hand over cnrricuh~rn hJI’-

mulation in its entirety to their learners, who

decide on the basis of their perception 01

relevance what shall or shall not 1)~ included.

Many teachers would regard this as a rash

misapplication of the ‘pupil-centrrd’ philosophy

of education ~ gilen that the tr.1 III ‘person-

or pupil-centred’ is open to w-ide individual

interpretation (Woods &r Barrow lclij Pertsaps

there is a case for each tcachrr formulating his

own ‘student-centrrd philosophy ’ ttl quidc him

in his teaching strategies. It is t.ertain aspects

of my philosophy that I ha1.r attempted to

share here: and lvhilr I lack tht. txruragc to

allow rn); learners to devise a w htrlr curricu-

lum which they see as interesting atrci r-c~lcvattt

(and which, presumably. will met-t their per-

ceived needs), I am convinced ot the impor-

tance of encouraging students to t1irt.t.t their

own learning for entire sessions 011 sul)jects 1

have chosen.

Regarding teaching strategies tilt more t’onl-

plex concepts, :\usubel 1 1978: \uggrstrd the

preliminary presentation of a gcnerali5ctl state-

ment an ‘advanced organisrr’ cc~ched in

language familiar to the learners. (:onsrquent

introduction of more detailed attrilnltes of that

complex concept are more l&cl\- IO lx undcr-

stood by the learners, sinc,e they ahead\- itw~I‘

something Onto which thcv cm build this ntw

information. Relationships between .tll these

subconcepts are thus mot-r rradil\ perceived,

and knowledge now approaches trut‘ u~Ider-

standing rather than an accumulation of‘ half-

remembered and unrelated ‘titcts’.

W’here complex concepts ate ittvcrl\-cd such

as ‘health and ‘caring‘ I tlic tlt~nt rr;tctlct needs to be aware of the possibility of gaps or

discontinuities in a xtudeIIt’\ kncnvlcdge.

whereby 1xoficienc.v. ~ e\~n distinc,lion ill 011e

area does not imply the same gr:rsi) 01‘ another.

Ideally, the nurse teacher stri\-es to bttild his

curriculum around the ‘naturr cut’ the knower’

(Bruner 1966) as much as the kr~~~\vledg~ itselt-

around the strengths and wraktrcxes of eat.11

individual learner. X well ilh iht’ YtltIYtLIIlC~C 01’

the lessons. Provision 01‘ at1 ‘:td\ iltrt.ecl or-

ganiscr at the Ircginnir~g 01‘ ;r I~Y,OII ]‘crtl”1’~

266 NURSE EDUCATION TODAY

in the form of skilfully contrived questions which both discover and inform) may serve as a means of assessing each learner’s conceptual position, from which point the lesson may validly proceed. Prepared lessons should, ideally, be regarded as adaptable rather than as immutable.

In nurse education both verbalism and the formation of pseudo-concepts can be danger- ous. ‘Naming’ is less satisfactory than ‘know- ing’, and ‘understanding’ is better than both. But can that knowledge, that understanding, be applied? For, after all, nursing entails prac- tical skills. Nurse education that is based upon

Teaching styles of different tutors in different situations are bound to vary. But whatever style is adopted, it would seem appropriate that, since most of our knowledge is conceptual by nature, the nurse teacher, aware of this, should seek to facilitate the learner’s develop-

ment of those concepts that she already has. The concerned nurse teacher does not regard himself as an oracle, but a resource. Education is not the presentation of ‘facts’ to a passive audience, but a lifetime of growth (both for ‘teacher’ and ‘taught’). As Bruner (1966) said, ‘Knowing is a process, not a product.’

the proper understanding of certain chosen concepts will, it seems, prepare the learner for References more efficient and fulfilling nurse practice than

will a training that seeks only to demonstrate Ausubel D 1978 Educational psychology: a cognitive view,

nursing ‘tasks’. In such a task-oriented situa- 2nd edn. Holt, Rinehart and Winston, New York, pp 170-173

tion where, for example, the nurse ‘does the Bruner J 1966 Towards a theory of instruction. Harvard

observations’, she may be unaware that ‘pulse’ University Press, Cambridge, Mass.

is a concept of some complexity (the attributes Child D 1981 Psychology and the teacher, 3rd edn. Holt,

of which need not be listed here). A patient’s Rinehart and Winston, London, pp 13%141

Cohen G 1977 The psychology of cognition. Academic

pulse may be taken with great skill, dut if its Press, London, pp 126-131

relevance escapes the nurse, if she is unaware of McNally D 1977 Piaget, education and teaching, 2nd edn.

the fullness of its implications, the patient’s Harvester Press, Hassocks, p 10

Postman N, Weingartner L 1971 Teaching as a subversive

health or even life may be in danger. ‘Pulse’, activity. Penguin Books, Harmondsworth, p 59

therefore, is not just a matter of a number, a Schwebel M, Raph J 1973 Piaget in the classroom.

calculation (however careful) or an entry on a Routledge and Kegan Paul, London, p 202

Stones E 1966 An introduction to educational psychology.

chart (however neat). ‘Doing the observations’ Methuen, London, p 163

is not a task performed primarily with a view Tomlinson P 1981 Understanding teaching: interactive

educational psychology. McGraw-Hill, Maidenhead, p to pleasing Sister. ‘Pulse’ is a concept of great 72

1

personal importance to the patient, *and tuhere- fore to the nurse practitioner. Nurse teaching

Vigotsky L 1962 Thought and language. First published in 1934. MIT Press; Cambridge, Mass., pp 6G-83

Woods R. Barrow R 1975 An introduction to philosophy of needs to take account of this. education. Methuen, London, p 140