Ward and Peterson Case StudyComprehensive Exam Part II

Kimberly WhitfieldApril 14, 2011

Who is this case study about?

Dr. Elizabeth Ward◦University faculty member who

teaches Healthcare in the nursing program

◦Expert in multicultural understanding within nursing

Catherine Peterson◦Instructional Designer for the Office

of Extended Studies (OES)

What is this Case Study About?

◦Designing and Developing a Web Course for Elizabeth’s existing Healthcare in Multicultural Environments Course and the Instructional Design implications

Case Analysis Questions Given Elizabeth’s passion for teaching and her

expert knowledge of the course content, how is this course redesign likely to affect Elizabeth’s interactions with her students?

What support could you provide in this environment to protect students who might make painful discoveries about themselves? What strategies could be used to deal with inappropriate and excessive disclosure of personal information?

Given the content and the learners, develop a course outline that will enable learners to achieve the course goals

Suggest appropriate methods for assessing learner performance.

Implications for ID practice

What are the advantages and disadvantages to using the web to deliver a course with a high level of affective subject matter?

What are the benefits and challenges of offering a course in cross-cultural communication via the web?

Discuss when and how it might and might not be appropriate to use the web to implement authentic assessment strategies.

Elizabeth’s Web Course InformationTitle – Healthcare in Multicultural

EnvironmentsGoal - “Students to arrive at an

understanding of the influence of cultural variation on clinical nursing practice and to use a culturally informed theoretical framework when considering patients’ symptoms during a cross-cultural patient-provider encounter.”

Why is this Important?Instructional Designers need to

know what Elizabeth’s course is about in order to determine the Instructional Design models and theories to follow

Domains of Learning

Cognitive – The development of understanding and intellectual abilities and skills

Psychomotor – The development of skills related to manual tasks and physical movement

Affective – Focus is on internal processes or categories of behavior within affective education as a process or end-product.

Krathwohl, Bloom and Maslas’ Taxonomy of the Affective Domain

Be aware of

Cultural Influences when

examining

patients

Martin and Reigeluth’s Conceptual Model of the Affective Domain

Components of instructional valueDimensions Knowledge Skills Attitudes

Emotional Development Knowing that others experience the same emotions you do such as joy and anger

Recognizing emotions, Controlling emotions

I want to be happy. I don’t like to be angry.

Moral Development Understanding moral and ethical rules of the culture, such as caring, justice, equality

Moral reasoning skills.Problem solving skills in the realm of morals

I want to be honest.I am in favor of having ethical standards.

Social Development Understanding group dynamics and democratic ideals, such as the role of the facilitator

Social skills, including interpersonal communication skills

I want to interact positively with others.I am opposed to resolving disagreements by fighting.

Spiritual Development Knowledge of religious precepts about the spiritual world, such as the nature of the soul.

Skills for getting in touch with your inner self. Ability to love others selflessly.

I want a spiritual life.I am in favor of prayer to build a relationship with God.

Aesthetic Development Understanding the subjective nature of aesthetics, such as the relationship between ones’ values and one’s judgments

Skills for assessing aesthetic qualities.Skills for generalizing aesthetic creations

I want to surround myself with things of beauty.I appreciate an elegant theory.

Motivational Development Understanding the internal and external rewards for sustained activity such as joy and sense of accomplishment

Skills for developing ones’ interests, both immediate and life long

I want a career that I enjoy.I am opposed to hobbies related to guns.

Problem solving skills in realm of moral

reasoning, specifically multicultur

al awareness

Intervene cultural

awareness developme

nt by integrating into course curriculum

Learning Theories

Behaviorism – B.F. Skinner, An orientation in psychology that emphasizes the study of observable behavior

Cognitivism – The mind is an information processing system where prior knowledge plays an important role in learning

Constructivists – Piaget, Learning is a process where learners construct new ideas or concepts based on past knowledge and experience

Teaching & Learning from Three Different Theoretical PerspectivesAdapted From H. H. Marshall (1992)Created by Mahnaz Moallem , MIT500

Behaviorist Cognitive Constructivist Social Constructivist

Learning Acquisition of facts, skills and conceptsOccurs through drill and practice

Active construction and reconstruction of prior knowledgeOccur through multiple opportunities and diverse processes to connect new knowledge to what is already knownOccurs through interaction with others and the environmentInvolves deep processing

Collaborative construction of socially defined knowledge and valuesOccurs through socially constructed opportunitiesOccurs through interaction with others and the environmentInvolves multiple processing (how to learn), and interpretations ( it means to learn, which knowledge is of value)

Teaching Transmission presentation (telling)

Challenge, guide thinking toward more complete understanding

Co-construct knowledge with studentsExpand repertoire of options of how to go about learning

Role of Teacher

Predefined as an adult Primary source of knowledgeManager or supervisor encourage on-time task completionCorrect wrong answers

Self or anyone with expertiseA source of knowledge (along with student, materials, and the environment)Facilitator or guide

Self or anyone with expertiseA source of knowledge (along with student, materials, social artifacts, and the environment)Facilitator or guideCo-participant

Role of Peers

Not usually considered Not necessary, but can stimulate thinking, raise questions

Ordinary part of the process of knowledge constructionContribute to definition of knowledge (in inter-subjective space of groups)Help define opportunities for learning

Role of Students

Recipient of knowledgeWorkerActive listener, direction-followerComplete work on time

Active construction (within mind)Generator, constructorActive thinker, explainer, interpreter, questionerUnderstand, question, explain

Active construction with others and selfSource of knowledge (group and individual within group)co-generator, co-constructorActive thinker, explainer, interpreter, questionerUnderstand, question, explainCo-construct, interpret social context

Structured design for Attitudinal Instruction (SDAI)Kamradt and Kamradt

Theory fosters Affective Domain Help learners change an attitude Examples:

◦ Learners will have a fuller understanding of how culture influences health care practices

◦ Learners choose to change the attitude of cultural understanding, and events help the learner maintain the new attitude and transfer it to real-life situations

SDAI Instructional Strategies

Move all three components of attitude (affective, cognitive and behavioral) the same amount in the same direction, using rapid shifts in instructional tactics, from one component to another

Offer learners a safe environment in which to try the new attitude

Course Structure for Elizabeths’ Web CourseSeparate lessons into learning chunks

in sequential orderAlign Gagne’s Events of Instruction

with course outline components to ensure learners achieve course goals

Created instructional strategies to apply Gagne’s Events when creating Elizabeth’s Web course.◦ Based my instructional strategies on Zhu

and StAmant’s method which uses Gagne’s Events applied to Web Teaching

Gagne’s Nine Events of Instruction

Course Outline Components Instructional Strategies for Web Course Application

Gaining Attention Course and Lesson Introduction

Introduction: Instructor tells stories of how culture affects communication in healthcare.Assignment: Students will find similar examples on the web and share their findings by posting them (use course discussion, blog, etc.)

Inform learners of objectives

Learning and Performance Objectives

Objectives: State the following course objectives at the beginning of the course. Recognize the broad cultural variation in clinical nursing practice. Apply a culturally informed theoretical framework.

Stimulate recall of prior learning

Pretest, Introduction, Case studies

Introduction: Ask learners to remember prior experiences in personal multicultural encounters and post their thoughts to share with others.Case Studies: Instructor presents a case study and provides solutions as an example of what is expected of the learner at the end of the lesson.

Presenting the stimulus(content)

Lessons and Topics Lessons or Topics: Present Videos of multicultural encounters with patients which describes cultural differences.

Providing learning guidance

Lessons, Topics Lessons: Ask focused questions about cultural differences for learners to think about while watching the videos.

Eliciting performance

Exercises, Assignments Exercises: Ask learners to review the Genogram Development Tool from the Web Course. Then ask learners to create their own Genogram using the tools provided within the course.

Providing Feedback Feedback Feedback: Instructor will provide feedback to exercises, assignments, assessments before moving on to the next task. Use the Web Course forum, discussion, chat, blog or email to facilitate communication and answer questions.

Assessing performance

Case Studies, Assessments or Assignments

Assessment: Watch the Video Vignettes of patient-provider encounters and engage in online dialog to discuss them.Case Studies: Provide case studies with posed so learners can practice their target skills by using relevant content knowledge to help them achieve their learning objectives.

Application of Gagne’s Events of Instruction using Instructional Strategies in a Web Course Outline

Course Outline

Healthcare in Multicultural Environments

Course Introduction

Provide course title, learning objectives, content summary, instructor contact information, materials or equipment needed to complete the course and a brief instructional flow of the course. Identify prerequisites and prior knowledge learners must have before taking the course. Include a time frame of how long it will take to complete the course.

Pretest

Test learners’ prior knowledge and align test items with performance objectives.

Lesson 1 Introduction to health care in multicultural environments.

Demographic trends, diversity vocabulary and common clinical challenges in multicultural health care environments

Introduction

Include title, time frame, content and purpose of the lesson

Identify prior knowledge required

List materials/Equipment needed to complete lesson

Provide instructional flow of lesson

Performance Objectives

Identify performance objectives for each lesson and/or topic

Topics

List lesson topics

Provide content, resources, case studies and materials

Provide examples

Exercises, Assignments and Assessments

Provide lesson or topic exercises or assignments as opportunities to practice what they have learned

Include enough resources and materials for learners to succeed

Assessments test learners’ knowledge after instruction

Align test items with lesson performance objectives

Provide feedback

Provide feedback at the lesson or topic level or both depending upon the complexity of the task

Redirect the learner to review lessons when they have not successfully completed the task

Praise the learner and allow them to advance to the next topic or lesson when they successfully complete tasks

Course Outline Continued..

Lesson 2 GenogramA picture of the relationships within a family, self-disclosure,

benefits of self- awareness and skills needed to assess patients’ heritagesLesson 3 Self-Awareness

Self-identity exercises, skills needed to assess patients’ cultureLesson 4 Theoretical Frameworks in nursing practice.

Advantages of a theoretical approach to nursing care, including cultural assessmentLesson 5 The viewing of symptoms through a theoretical lens

Symptoms as merely symptoms, explanatory models, idioms of distress, semantic illness networks, fold illnesses and the analysis of illness narrativesLesson 6 Cross-Cultural communication standards and skills

Outcomes of provider-client (mis)communication, implications of differences between patients and providers in terms of

language, semantics and disease classification and the elicitation of illness narratives cross-culturally Posttest – (After course completion)

Test learners knowledge after instructionAlign with performance objectiveDevelop similar or parallel test items used in pre-test

Provide feedback – (After posttest)Provide feedback at the end of the posttestRedirect the learner to review the lessons with poor assessment

results Praise the learner for successful completion of the course

Assessments for Affective Domain Case Studies - Learners can practice their target skills by

using relevant content knowledge to help them achieve their learning objectives

Videos - Watch the Video Vignettes of patient-provider encounters and engage in online dialog to discuss them

Projects - Learners will form groups and apply using culturally informed theoretical frameworks and cross-cultural communication skills by completing a course project

Report Paper - Students to reflect on their understanding of the course objectives by writing a commentary about how they felt at the beginning of the course; how they feel now and how will they put what they have learned into practice

Likert Scale -Learners can check a box to determine if they “strongly agree”, “agree”, “undecided”, “disagree” or “strongly disagree” in response to attitudinal statements

Challenges and disadvantages for sensitive subject matter Develop trust and ensure privacy when assessing

learners thoughts and feelings about subject matter◦ Prevents exposure of inappropriate personal

information.◦ Promotes honest responses from learners

May not know future audience• Designer will know intended audience but may not

know future audiences• Have learners register for course attendance and

change course as needed Scaffolding and Supporting Student Learning

◦ Support learners, focusing tasks, environment, teacher and learner

◦ Genogram example: learners may discover painful family facts when isolated from group. May not be appropriate to develop personal Genograms but use a biography of a “fictional” student instead

Benefits and advantages for sensitive subject matter The Web enables use of multimedia content Easier to create and edit course content

◦ Can be embedded or linked to from within course◦ Example: VoiceThread

Ensures Privacy◦ Learners can discover attitudinal concepts about

themselves without fear of exposure◦ Anonymity can be beneficial and allow learners

freedom of expression without bias or intimidation◦ Makes learning more personal as Gagne states,

enhance retention and transfer learning

ConclusionInstructional Designers can design and develop

a successful course for Web-based instruction as long as they know:◦ Domains of Learning◦ Learning Theories and Models◦ Instructional Design Theories and Models◦ How to apply Theories and Models◦ Instructional Design Process

Analyzing, designing, developing, implementing and evaluating instruction intended for successful learning outcomes

Design for the Affective Domain may be more difficult than for the other Domains of Learning it is possible, and successful learning outcomes can be obtained when these principles are followed

References

Dick, W., Carey, L., Carey, J. (2005). The Systematic Design of Instruction, Boston, MA: Pearson Education Inc.

 Marshall, Hermine H. (1996). Clarifying and Implementing Contemporary

Psychological Perspectives, Educational Psychologist, 31: 1, 29 — 34 Marshall, G., Scott, J. ED (2005). The Oxford Dictionary of Sociology, New

York, NY: Oxford University Press.  Moallem, Mahnaz (2008). MIT500 Instructional Systems Design: Theory and

Research [Lecture notes]. Wilmington, NC: University of North Carolina Wilmington, Department of Instructional Technology.

 Reigeluth, Charles, M. (1999). Instructional-Design Theories and Models:

A New Paradigm of Instructional Theory, Volume II (pp. 485-509, 551-561 and 564-590). Mahwah, NJ: Erlbaum.

 Seels, Barbara and Glasgow, Zita (1998). Making Instructional Design

Decisions, (pp. 60-64 and 179-187). Upper Saddle River, NJ: Prentice Hall. Zhu, Pinfan and StAmant, Kirk (2010). An Application of Robert Gagne’s

Nine Events of Instruction to the Teaching of Website Localization, Journal of Technical Writing and Communication, Vol. 40(3) 337-362, 2010.