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New Directions in Teaching and Learning Within Nursing
EducationNew Mexico Statewide Nursing Faculty Conference
June 3-4, 2009
Jean Giddens, PhD RN, ProfessorInterim Senior Associate Dean for Academic Affairs
College of Nursing, University of New Mexico
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Student Centered LearningDecades 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
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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
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Emergence of New Paradigms
• Conceptual Approaches to Teaching and Learning
• Virtual Experiential Communities
• Student centered learning
• Integrative teaching
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TEACHING AND LEARNING DIFFERENTLY: THE CONCEPTUAL APPROACH
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Example: Concepts as Categories
What concepts do the shapes below represent?
What other concepts can you identify?
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Example: Concepts as Categories
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What is Conceptual Teaching and Learning?
The difference between concept- and content-focused learning is… “the difference between facts of the Alaska oil spill and an understanding of the importance of environmental sustainability” (Erickson, 1998 p. 50).
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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.
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Pneumonia COPD
Anemia Pulmonary Edema
Pnuemothorax
Oxygenation
PE
RSV
RDSAMI
Asthma
Concept: Oxygenation and possible exemplars
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Pneumonia
COPD
Oxygenation
RSV
Asthma
Concept: Oxygenation & selected exemplars
OtherConcepts
OtherExemplars
Exemplars
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Teaching ConceptuallyFocus on Concept
Exemplars provide content knowledge
Application of content to interrelated concepts
Application of other content to the concept
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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
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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.
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• Hypertension• ASHD• Renal Failure• Diabetic
Retinopathy• Peripheral
Neuropathy• Peripheral Artery
Disease
Example:Long-term complications of DM
• How could you teach this so students can understand the underlying concept or concepts could explain this?
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Example:Skill Acquisition-
Securing an IV Catheter
• What concept(s) apply?• How could you apply this
to your skills lab teaching?
• After starting an IV, what steps are necessary to properly secure the IV?
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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.
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Courses and Course Objectives
Class Sessions Class Session Objectives Class Learning Activities
Level Objectives/Competencies
NURSING PROGRAMMission Statement Goals Philosophy
INSTITUTION
Mission Statement Goals Philosophy
CURRICULM FRAMEWORK
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Knowledge, Concepts & Theory
• Knowledge is represented through concepts• Concepts are building blocks of theory
THEORY
Concept Concept Concept Concept
Concept ConceptConcept
Knowledge
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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
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Benefits
• 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
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Drawbacks• Resistance to change• Requires a different level of
organization• Students may be resistant (at first)• Lack of literature detailing steps• What about NCLEX?
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VIRTUAL EXPERIENTIAL COMMUNITIES
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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?
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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?
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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?
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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)
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Giddens - ODU, 2008
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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.
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Nurse Characters
• 6 featured nurse characters that work in 4 health-care 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.
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Biographical Information
Each character has biographical information that serves as an introduction.
Updated each semester to reflect previous semester story.
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Weekly Story
Each character has a story update each week.
Stories unfold weekly over 3 academic semesters.
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Photos & Video Clips
Stories are extended with photos, and video clips as applicable.
These media enhance understanding beyond text.
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Medical Record
• Abbreviated medical records included to provide an understanding of health care.
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Newspaper
• The newspaper links individual characters to the community
• Is reflective of contemporary social, ethical, and health related issues.
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BENEFITS OF LEARNING WITH VIRTUAL EXPERIENTIAL COMMUNITIES
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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).
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Comparisons – Heart FailureTraditional Approach
- A & P- Pathophysiology- Signs/Symptoms- Dx tests- Treatment- Nursing Interventions &
patient teaching
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 = acute phase; perspective of the nurse
Context = daily life; perspective of individual
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What is the Link to Nursing
• Clinical Judgment Model (Tanner)– 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
PHASE OF NURSING CARE
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Common Teaching Strategies
• Incorporated in Lecture• Case Study• Role Play• Games• Care Plan• Creative Writing
• Simulation• Compare and Contrast• Concept Map• Debate• Concept Analysis• Policy Analysis
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What Do You Want Students To Do?
• 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
• 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
Learning Activities that are Purposeful
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FUTURE DIRECTIONS
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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
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Alternative Applications
• Population specific virtual communities• Application for multidisciplinary health care
education• Application for other disciplines
– K-12– Social Work– Construction Management