Over the last few decades, Australian healthcare systems have experienced unprecedented changes that have resulted in a reduced life span of information that is deployed in evidence-based practice. This reduction has affected the education of healthcare professionals who must be prepared for continuous learning in an environment of sophisticated healthcare practice. To substantiate this claim, Harpaz, Balik, and Ehrenfeld (2004) confirm the “growing awareness of the need for changes in nursing education systems, especially in developing self-learning techniques, where the student is an active participant in the learning process” (p. 27). Hence, due to the immense amount of information that students must learn within a limited time, healthcare education has a noble obligation of reconsidering instructional techniques and teaching strategies for people who provide healthcare services in Australia and in the global context. Indeed, healthcare educators agree that the effectiveness of future healthcare will call for an alteration of strategies for teaching people who provide the services. According to Woodward (2000), “Such initiatives need to be reviewed with the explicit goal of determining the educational and other resource needs of health personnel to deliver quality care given the new circumstances” (p. 10).
Healthcare educators need to ensure that students acquire critical thinking abilities while at the same time fostering problem-solving capabilities via strategies that promote active learning (Pijl-Zieber, Barton, Konkin, Awosoga, & Caine, 2014). Corresponding to the changing contexts of practice in healthcare, active learning aids in shifting traditional teaching approaches that were mainly teacher-centred to learner-centred approaches. In this context, this paper analyses and synthesises humanistic, social, cognitive, and behavioural theories with the critical objective of examining their applicability in promoting this active learning teaching approach.
Background to Active Learning
Active learning is a technique of instruction that puts students to task when it comes to learning. As Weltman (2008) puts it, “in active learning, students participate in the process and students participate when they are doing something besides passively listening” (p. 7). Traditionally, instructors assumed the active process of teaching while students only tuned in with no proof of whether they understood what was taught or not. However, with active learning, students go beyond listening. They have to read, compose, deliberate on what is taught, and/or be occupied with taking care of life issues (Gyurko, 2014). Active learning persuades learners to be involved in activities that require deep thinking such as assessment, analysis, and brainstorming. In active learning, learners not only study but also take time to do a thorough examination of the content that is presented to them.
Teaching approaches that foster active learning require students to be responsible in their learning to enhance their knowledge and skill attainment. Through active learning, educators in healthcare settings do not deploy tactics that lead to spoon feeding learners with facts or theoretical constructs (Hegazi & Wilson, 2013). Rather, focus shifts to learners’ participation in the development of facts, concepts, good understanding, and application of evidence-based principles in clinical work (Alexander, Kernohan, & McCullagh, 2004; Stanley & Gannon, 2008). Through such teaching approaches, learners acquire effective learning tactics and higher knowledge levels that are necessary in clinical or medical work environment that is characterised by consistent changes in the manner in which people work or deliver care based on the emerging technologies.
Active learning fosters critical thinking. It also guarantees the participation of students in problem solving (Douglas, 2011; Henderson et al., 2010). Its traits include emphasising the development of various cognitive skills, learner participation in chores that enhance their attitude and value. These concerns imply that humanistic, social, cognitive, and behavioural theories can be utilised by healthcare educators to demonstrate knowledge of theories, concepts, and principles that underpin active learning.
In nursing, instructors must have a clear criterion of how they will facilitate the active learning session, including the skills needed and the mode of presenting the selected theories in class. In clinical environments and GP settings, cognitive, social, and humanistic theories best inform active learning approaches to teaching. Kuiper and Pesut (2004) support this view by arguing that the effectiveness of reasoning in clinical nursing settings is a function of having acquired meta-cognitive and cognitive skills. However, despite this realisation, educators in the clinical nursing field have not yet implemented and/or tested any predictions concerning the development of these skills. Through their study on self-regulated learning, Kuiper and Pesut (2004) reveal that meta-cognitive skills coupled with cognitive skills are important predictors of the development of clinical reasoning skills.
Australia transferred nursing education into the sector of higher education. The objective of accomplishing this task was to create nurses who would think critically. However, Grealish and Smale (2011) argue that this move was negatively impaired by the practice of clinical nursing education that was naturally implicit. Consequently, to address the challenges, the authors suggest that Australia should implement scientific prospectus that is founded on collective and cognitive learning presumptions, which guide clinicians’ prospective talents to contain the progressively complex and critical learning demands of tertiary-based medical learners (Grealish & Smale, 2011, p.51). This suggestion underlines the importance of using social and cognitive teaching approaches to enhancing active learning process in a GP setting and clinical or classroom environment for nurses and midwives. Indeed, nurses undergo a continuous learning process with the help of educators in clinical nursing (Govranos & Newton, 2014). Such learning should draw on the nurses’ developed experience and cognitive skills to help in critical reasoning through new challenges.
Thinking processes encompass various activities that entail the perception of stimuli that are acquired from external environment and then encoded and stored in the mental recesses (Proctor & Vu, 2006). Situation modification involves the utilisation of experience in the effort to ensure that a person can handle similar issues in the future. The process calls for analysis and encoding of memories. In the obstacle evaluation pillar, people must take into perspective the nature of problems or obstacles that one is subjected to in the effort to determine precision in terms of students’ cognitive talents, intellectual ability, and/or problem-solving skills (Hmelo-Silver, 2009). This plan is essential in solving any emerging challenge in a GP setting (doctors) and clinical or classroom environment for nurses and midwives (Geffen, 2014).
One of the current approaches to consider when teaching in a GP setting (doctors) and clinical or classroom environment for nurses and midwives in Australia is the inter-professional education (Lapkin, Levett-Jonnes, & Gilligan, 2013). This approach encourages knowledge sharing, synthesis, and analysis in terms of how the skills acquired in classroom situations apply to practical situations, including how it can be adapted to address any emerging challenges in the medical field. Consequently, educationists must encourage problem-solving and critical thinking learning approaches. The approaches form the basic tenets of active learning from cognitive and humanistic perspectives. The objective of healthcare services entails providing quality care in a safe way. Indeed, Evans, Ellis, Norman, and Luke (2014) note that the delivery of safe healthcare services calls for educators to embrace taking the full challenge of ensuring that learners can offer services in an effective way when they get into practice. This option is not only important in a GP setting but also in a clinical or classroom environment for nurses and midwives.
For active participation of learners in the medical field in the learning process, it is important to adopt teaching strategies that meet the learners’ needs. In this context, Hosford and Sanders (2010) argue that educators need to incorporate learners’ learning styles teaching to facilitate the learning process. Consistent with this assertion, the authors conducted a research on in-house steadiness of medical learners’ feedback to the index of education techniques (ILS) (Hosford & Sders, 2010). Their goal was to determine the appropriateness of the index as a good instrument for analysing medical education. Hosford and Sders’ (2010) results indicated that students’ feedback concerning the ILS correlated positively with the purposes for which the system served. Students’ preferences for sensing coupled with visual learning were found to be moderate. Hence, Hosford and Sders’ (2010) research supported the importance of ILS in establishing the preferred learning styles for students in the medical profession. This finding underlines the significance of humanistic approaches to not only active learning in a GP setting but also in clinical or classroom environment for nurses and midwives. The theory calls upon educators to design teaching approaches that meet the students’ individual needs such as learning styles.
Social theory or the theory of constructivism may be compared to the process of constructing a building. The theory holds that people learn through attaching meaning to the things they encounter. Constructivism is similar to the construction of a building in the sense that it holds that knowledge is structured starting from the most fundamental to the most advanced levels in the memory of an individual. Its retrieval also calls for consecutive evaluation of the information layers (Shaki & Gevers, 2011). From the paradigm of this theory, the learning process is a social activity, which calls for collaboration and negotiations of various learning community members. These members include learners and instructors. Instructors facilitate information sharing by engaging learners in challenging activities (Reiser & Dempsey, 2012). This strategy has the implication of fostering critical thinking and the evaluation of concepts learnt. Social theory postulates that teachers have the role of considering the experiences and knowledge that learners bring in classrooms. This role is necessary since learners may construct their knowledge and skills by participating in active inquiry.
Under the behaviourist theory, learners are passive participants in the learning process (Mitchell et al., 2013). They only respond to various stimuli. The teacher has the responsibility of shaping the behaviour of learners positively through strategies such as reinforcing their understanding. Under the behavioralist theory, educators also have the responsibility of assessing learners through tests with the objective of determining their capacity to grasp materials taught in class. Behaviorism differs from humanism in the sense that humanism focuses on rewarding oneself by learning while behaviourism focuses on receiving rewards from others. Behavioralism entails helping and aiding learners to achieve their full potential. Learning strategies should also ensure that the participants’ needs are met while at the same time satisfying learners’ emotional and behavioural development.
Humanistic Learning Theory
Humanistic approaches to learning suggest that educational systems should focus on developing learners’ self-concept. It holds that learners acquire knowledge since they are internally motivated and driven to learn and “derive their reward from the sense of achievement that having learnt something affords” (Owen, & Grealish, 2006, p.17). Similar to the social theory of learning, humanistic learning theory regards learners as active participants in the learning process. It holds that teachers have the responsibility of creating contexts that foster a feeling of safeness while at the same time questioning and reflection on the acquired knowledge. Students have the responsibility of participating in the education process by actively participating in the learning process (Forsyth, 2014). It calls upon educators to facilitate and motivate learners to deploy their learning strategies in achieving their self-perfection.
Cognitive Learning Theory
Cognitive learning theory mainly focuses on brain and its contribution to the learning process. It develops concepts such as schemas, including how they contribute to the learning process through information comparison. Cognitive learning theory holds that learners have the responsibility of storing and retrieving information that helps to create knowledge that is necessary for living and work practice (Frambach, Driessen, Chan, & Vleuten, 2012). Educators manage learners’ problem-solving process while at the same time structuring the learners’ search activities (Hunt, McGee, Gutteridge, & Hughes, 2012). This process is critical in boosting learning strategies that involve a group of learners. The international trend in healthcare professional education has mainly focussed on active learning approaches to teaching and learning. It has replaced the more traditional approaches. Are there any factors that the involved parties need to consider when applying these four theories of learning apply in a GP setting (doctor) and clinical or classroom environment for nurses and midwives? The next section responds to this question.
Considerations to achieve Active Learning Engagement
Establishing a new instruction method may be a challenge, not only to the teachers but also to the learners. Hence, stakeholders need to adhere to various considerations that help to achieve active learning engagement when planning teaching sessions in a GP setting (doctors) and clinical or classroom environment (nurses and midwives).
It is crucial to appreciate that different students learn differently. Therefore, it is necessary to deploy teaching approaches or styles that meet the specific needs for nursing learners while enhancing their active learning. Such approaches include deploying teaching that facilitates problem solving and team learning. Schnetter et al. (2014) provide the necessary considerations for enhancing active learning in the nursing setting by noting that educators who seek to encourage active learning need to consider deploying teaching approaches such as role play, demonstrations through simulations, and utilisation of online-teaching approaches to enhancing student engagement and participation in the learning process (Duffy, 2001). This consideration underlines the necessity of re-designing teaching and learning approaches that are deployed in nursing settings. The new design should shift from upholding theoretical approaches to integrating various active learning strategies such as workshops that provide hands-on experience and direct interactions of students and the teacher through various techniques, for instance, face-to-face discussion forums (Mann, 2011).
Active learning implies that teachers should have adequate time to engage with learners. This plan considers the sizing of nursing classes appropriately. When planning for teaching sessions, it is necessary to consider versatile needs of learners who belong to a particular class. Hence, teachers need to focus on delivering course materials while at the same time guaranteeing student readiness to absorb them (materials) and/or relate them to practical applications (Bastable, Gramet, Jacobs, & Sopczyk, 2011). Therefore, it is necessary to consider the capacity of the course material and their delivery approach to meet the learning styles and needs of the target class. Tutors need to consider information gaps when designing lectures. Failure to consider such gaps might create information discontinuity in the learners. Such a consideration can warrant good structuring of lectures in the nursing field in a manner that increases students’ learning outcomes (Kibble & Kay, 2016). Consequently, students will seek additional information that magnifies knowledge attainment, a phenomenon that encourages learners to be actively involved in the learning process.
Based on the expositions made in the paper, it suffices to regard learning as not only necessary to people who are new in the medical or nursing profession but also those who are already practicing. New challenges in a profession require the development of a new set of skills. In a GP setting and clinical or classroom environment for nurses and midwives, the paper has argued that active participation of learners in the teaching process is important to increase ether cognitive skills, problem-solving, and critical reasoning. This process requires teaching approaches that meet individual students’ learning abilities to increase their (students) ability to grasp knowledge and skills that can be applied in a variety of contexts. To this extent, the paper has identified humanistic, cognitive, and social learning theories as important components that foster active learning in a GP setting, including clinical or classroom environment for nurses and midwives. Besides, it has shed light on various issues that nursing educators should consider if they wish to achieve active learning engagement when planning teaching sessions in a GP setting and classroom environment.
Alexander, S., Kernohan, G., & McCullagh, P. (2004). Self directed and lifelong learning. Studies in Health Technology Information, 10(9), 152-66.
Anthony, S., & Jack, S. (2009). Qualitative case study methodology in nursing research: an integrative review. Journal of Advanced Nursing, 65(6), 1171–1181.
Bastable, S., Gramet, P., Jacobs, K., & Sopczyk, D. (2011). Health professional as educator. Principles of teaching and learning. Burlington, MA: Jones & Bartlett Learning.
Douglas, M. (2011). Opportunities and challenges facing the future global nursing and midwifery workforce. Journal of Nursing Management, 19(6), 695–699.
Duffy, M. (2001). A critique of cultural education in nursing. Journal of Advanced Nursing, 36(4), 487-495.
Evans, A., Ellis, G., Norman, S., & Luke, K. (2014). Patient safety education –A description and evaluation of an international, interdisciplinary e-learning programme. Nurse Education Today, 34(2), 248-251.
Forsyth, K. (2014). Lessons learned in developing new postgraduate medical specialist training programmes for Australia and New Zealand. MJA, 201(9), 511-512.
Frambach, J., Driessen, E., Chan, L., & Vleuten, C. (2012). Rethinking the globalisation of problem-based learning: how culture challenges self-directed learning. Medical Education, 46(3), 738-747.
Geffen, L. (2014). A brief history of medical education and training in Australia. MJA Centenary, 201(1), 19-22.
Govranos, M., & Newton, J. (2014).Exploring ward nurses’ perceptions of continuing education in clinical settings. Nurse Education Today, 34(5), 655-660.
Grealish, L., & Smale, A. (2011). Theory before practice: implicit assumptions about clinical using education in Australia as revealed through a shared critical reflection. Contemporary Nurse, 39(1), 51-64.
Gyurko, C. (2014). A synthesis of Vroom’s model with other social theories: An application to nursing education. Nurse Education Today, 31(2), 506-510.
Harpaz, I, Balik, C., & Ehrenfeld, M. (2004). Concept mapping: an educational strategy for advancing nursing education. Nursing Forum, 39(2), 27-30.
Hegazi, I., & Wilson, I. (2013). Maintaining empathy in medical school. It is possible. Medical Teacher, 35(12), 1002-1008.
Henderson, A., Twentyman, M., Eaton, E., Creedy, D., Stapleton, P., & Lloyd, B., (2010). Creating supportive clinical learning environments: an intervention study. Journal of Clinical Nursing, 19(2), 177–182.
Hmelo-Silver, E. (2009). Problem-based learning: What and how do students learn? Educational Psychology Review, 16(3), 235-266.
Hosford, C., & Sders, W. (2010). Felder-Soloman’s index of learning styles: internal consistency, temporal stability, and factor structure. Teaching and Learning in Medicine, 22(4), 298-303.
Hunt, L., McGee, P., Gutteridge, R., & Hughes, M. (2012). Assessment of student nurses in practice: a comparison of theoretical and practical assessment results in England. Nurse Education Today, 32(1), 351–355.
Kibble, J., & Kay, D. (2016). Learning theories 101: application to every teaching and scholarship. Advanced Psychological Education, 40(1), 17-25.
Kuiper, R., & Pesut, D. (2004) Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. Journal of Advanced Nursing, 45(4), 381–391
Lapkin, S., Levett-Jonnes, T., & Gilligan, C. (2013). A systematic review of the effectiveness of interprofessional education in health professional programmes Nurse Education Today, 33(2), 90-102.
Mann, K. (2011). Theoretical perspectives in medical education: past experience and future possibilities. Medical Education, 45(1), 60–68.
Mitchell, R., Jamleson, J., Parker, J., Hersch, F., Walner, Z., & Moodle, R. (2013). Global health training and postgraduate medical education in Australia: The case for greater integration, MJA, 198(6), 316-320.
Owen, J., & Grealish, L. (2006). Clinical education delivery–A collaborative, shared governance model provides a framework for planning, implementation and evaluation. Collegian, 13(2), 15–21.
Pijl-Zieber, E., Barton, S., Konkin, J., Awosoga, O., & Caine, V. (2014). Competence and competency-based nursing education: Finding our way through the issues. Nurse Education Today, 43(5), 676-678.
Proctor, W., & Vu, L. (2006). The cognitive revolution at age 50: has the promise of the information processing approach been fulfilled? Journal of Human Computer Interaction, 23(5), 253-284.
Reiser, R., & Dempsey, J. (2012). Trends and issues in instructional design and technology. Boston, MA: Pearson.
Schnetter, V., Lacy, D., Jones, M., Bakrim, K., Allen, P., & O’Neal, C. (2014). Course development for web-based nursing education programs. Nurse Education in Practice, 14(6), 635-640.
Shaki, S., & Gevers, W. (2011). Cultural characteristics dissociate magnitude and ordinal information processing. Journal of Cross-Cultural Psychology, 42(2), 639-650.
Stanley, J., & Gannon, J. (2008). The clinical nurse leader: a catalyst for improving quality and patient safety. Journal of Nursing Management, 16(5), 614-622.
Weltman, D. (2007). A Comparison of Traditional and Active Learning Methods: An Empirical Investigation Utilising a Linear Mixed Model. Texas: The University of Texas.
Woodward, C. (2000). Improving Provider Skills: Strategies for assisting health workers to modify and improve their skills: Developing quality healthcare-a process of change. Hamilton, Ontario: McMaster University.