Learning Theories Application in Nursing Education

Introduction

A portfolio is a tool that is being implemented by various groups of people who participate in learning that allow documenting and subsequently assessing their performance (Birks, Hartin, Woods, Emmanuel, & Hitchins, 2016; Kim & Yazdian, 2014; Loeb, 2011; Ryan, 2011). Apart from that, it is apparent that a portfolio is a means of communicating, which is especially true for teaching portfolios that bear the evidence of specialists’ practice, which is worth sharing and discussing (Loeb, 2011, p. 205). Finally, portfolios are a means of promoting reflection and reflective learning, which is as necessary for educators and learners alike (Birks et al., 2016). If experience is regarded as a source of knowledge and learning, reflection is the tool that allows enhancing this learning (Dubé & Ducharme, 2014).

A teaching portfolio can be organised in varied ways, but it is supposed to demonstrate the achievement of the learning objectives that is illustrated by the evidence of learning and to include the plans for future improvement (Loeb, 2011). The presented portfolio includes the description and justification of lesson session content and elements and the reflection on its practical application. The practicum uncovered specific areas that require attention due to their difficult or challenging nature and provided the ground for the future action plan. Apart from that, the portfolio aims to demonstrate the link between my teaching practice, cognitive theory of learning, and active learning, an approach that is being actively promoted nowadays in particular with respect to nursing (Herinckx, Munkvold, Winter, & Tanner, 2014; Waltz, Jenkins, & Han, 2014).

Session Content and Plan (Justification)

Teaching Plan and Practicum

Teaching plan needs to include not only the objectives of learning but also the means of helping the students to achieve them while also taking into account the specifics of the environment, learners, and educator. The most important steps include knowledge assessment and planning proper that are supposed to be implemented and later evaluated to define the level of success, determine the future actions that can ensure the achievement of the learning objectives, and to and continuously improve one’s practice (Fowler, 2012; Wonder & Otte, 2015).

The practice took place on May 16th, 2016 at Ferndale Garden, Bayswater. The lesson included a PowerPoint presentation with a lecture, discussions, brainstorming, questions and answers, and a test meant to assess the outcomes and help the students in learning. I was the educator, and the audience included registered nurses, who were interested in improving their competence. The lesson took slightly less than 30 minutes, and it was devoted to ABGs interpretation.

Knowledge Assessment

The learning objectives and outcomes should be linked to students’ needs (Hauer & Quill, 2011). Defining the needs of the learners is one of the key elements of teaching that can help to customise and, therefore, enhance the learning experience (Fowler, 2014). In this case, the knowledge assessment is planned as a part of the lesson, and the presentation, lecture, as well as active learning elements allow modifying the plan to address the aspects that pose difficulties for the learners, are unknown to them (knowledge gaps) or simply can be considered most significant.

However, during this practice, the plan was not modified noticeably due to the fact that learners’ knowledge level was varied. Still, they actively contributed to the discussion of the key concepts, which made the experience positive and useful for all of them through knowledge sharing. Apart from that, the lesson was aimed at ensuring the understanding of ABGs interpretation rather than its simple memorizing, which is much more effective (Habermann & Ghosh, 2008). As a result, students were encouraged to develop or demonstrate this understanding, which they successfully did during discussions.

It is also noteworthy that the knowledge assessment helped to identify students’ expectations, which in this case corresponded to the learning objectives. Students’ expectations can define their motivation, and during this practice, the latter seemed to be quite high (Haraldseid, Friberg, & Aase, 2016).

Topic Justification

In this plan, the knowledge assessment takes place as the first part of the lesson, but the need for this lesson can also be justified by the fact that the topic is indeed of vast importance. In fact, the ability to interpret ABGs is a vital skill that allows nurses to get an insight into the state of a patient (Blevins, 2014a). Apart from that, the interpretation is vastly facilitated in case the learners understand its principles rather than drill the specific causes, although, admittedly, a certain amount of drilling is required for the topic as well (Habermann & Ghosh, 2008). Finally, the continued practice is of immense importance for nursing education (Dubé & Ducharme, 2014). As a result, the need for the instruction on the topic of ABGs that is specifically aimed at understanding it is justified.

Teaching Styles

Nowadays, teachers are expected to know about and employ varied teaching strategies and approaches to suit their learners’ needs (Jokinen & Mikkonen, 2013). The teaching style for this lesson is defined by two factors: the needs and learning styles of students and the cognitive theory as applied to nursing. The former aspect is concerned with the fact that learners have different learning styles and needs (Blevins, 2014b), which defined the varied activities involved in teaching, including oral presentation, visual information in the PowerPoint file, and the student engagement components. The latter components include the classic activities of discussions and brainstorming that tend to engage students in the learning process, and that can be defined as “active learning” (Lubeck, Tschetter, & Mennenga, 2013). Apart from that, the focus of cognitive theory on the learner was the key concern for the educator during this lesson (Aliakbari, Parvin, Heidari, & Haghani, 2015). As a result, the plan is focused on assisting the understanding and memorizing of the information and engaging the students as a part of the teaching style. Active learning, therefore, became another significant aspect of the teaching style, which corresponds to the modern tendencies of introducing this approach in the nursing learning environment (Herinckx et al., 2014). Finally, the use of powerPoint presentation is in line with contemporary teaching models that are specifically aimed at employing modern technology to facilitate the learning process (Kroning, 2014).

Learning Styles

The learning styles of students tend to vary, and they need to be considered to enhance the learning process. Similarly, students’ expectations can affect their motivation and engagement willingness (Haraldseid et al., 2016). The learning styles can define the sources and means of acquiring knowledge (for example, personal experience or peer experience reflection) as well as the preferable channel of perception (for example, visual information) (Rassin, Kurzweil, & Maoz, 2015). This fact could be regarded as an obstacle, but it can also be used to improve the learning experience by including several types of learning sources, which is supposed to enhance the knowledge acquiring process for respective students (Blevins, 2014b). For example, the presented lesson contains visual information, a lecture and peer ideas sharing, which means that the knowledge sources are multiple. Moreover, students can be flexible in their learning practice just like teachers can adjust their learning styles (Baraz, Memarian, & Vanaki, 2014). As a result, the different opportunities offered by this plan should help students with varied learning styles.

Learning Objectives

Five distinct and equally significant learning objectives have been singled out, even though the processes of their achievement are mostly interconnected. These objectives are relatively short-term; long-term ones include the development of the nurses’ competence that would enable them to demonstrate high-quality performance with respect to ABGs interpretation and healthcare in general and the enhancement of their confidence in their skills in the area.

Define what ABGs is and explain the need for interpretation. Define what normal ABGs are. In order to make this part of the lesson shorter, the educator provides an oral presentation that is supported by the PowerPoint one. The students receive the general overview of ABGs, the need for their interpretation, and the information gained through this interpretation.

ABGs (arterial blood gases) are interpreted to gain the insight into the patient’s status (Pruitt, 2010). Their interpretation is concerned with the following major elements: pH (that defines the acidity/alkalinity of blood), Paco2 (carbon dioxide partial pressure), Pao2 (oxygen partial pressure), HCO3- (bicarbonate ions concentration), and Sao2 (“the percentage of haemoglobin saturated with oxygen”) (Pruitt, 2010, p. 32). All of these parameters have a range that defines normal ABGs (students are presented with the table of normal ranges for adults). As a result, ABGs interpretation can be defined as “an objective measure of acid-base balance, oxygenation, and ventilation” that also allows “determining the level of compensatory mechanisms” (Blevins, 2014a, p. 185). The speech of the educator makes this part of the lesson shorter; learners are invited to ask questions to avoid misunderstandings.

Define acidosis, alkalosis, respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. The six terms are discussed by the educator and the students to ensure that the latter understand the mechanisms of the development of every disorder. This part of the lesson requires greater learners’ participation to ensure their understanding of the information. As a result, this part of the lesson is the longest.

It is apparent that acidosis is connected to lower pH (acidotic pH is below 7.35) while alkalosis is defined by alkalotic, high pH (over 7.45). Both can be respiratory or metabolic. Respiratory acidosis is related to hypoventilation that leads to the retention of carbon dioxide while respiratory alkalosis is caused by hyperventilation and leads to the decrease in carbon dioxide. Metabolic status is defined by the HCO3, and metabolic acidosis is the result of acid accumulation that is greater than normal while metabolic alkalosis leads to increased pH and bicarbonate (Habermann & Ghosh, 2008, p. 131-133; Blevins, 2014a, p. 185). It is important that the students learn these mechanisms before specific causes are named. However, it is noteworthy that this part of the lesson is very organically connected to the following one.

Enumerate the causes of respiratory acidosis & and alkalosis and those of metabolic acidosis and alkalosis. Having brainstormed the causes for all the four disorders together with the learners, the teacher enumerates them. The causes of acute respiratory acidosis include “depression by drugs such as narcotics, central nervous system injury, acute diaphragm or neuromuscular weakness, severe parenchymal respiratory failure, and cardiac failure” while those for chronic one presuppose various states “associated with chronic alveolar hypoventilation” (Habermann & Ghosh, 2008, p. 132). Respiratory alkalosis results from hyperventilation, which defines its causes: various states that are connected to anxiety or pain, mechanical overventilation, early shock states, central nervous system disorders, “hypoxemia, hypothermia, salicylate intoxication, liver failure”(Habermann & Ghosh, 2008, p. 132). Metabolic acidosis causes include “tract losses of bicarbonate (diarrhea), urinary diversion procedures, and intestinal fistulas” for non-anion gap acidosis and “diabetic ketoacidosis, lactic acidosis, uremia, and toxins” for the increased anion gap one (Habermann & Ghosh, 2008, p. 132). Metabolic alkalosis is typically caused by volume contraction states, especially in case the losses are concerned with chloride and hydrogen ion, for example, through vomiting (Habermann & Ghosh, 2008, p. 134).

This part is shorter than the previous one. Also, the final following part is technically embedded in the discussion of this one.

Define anion gaps. This part is devoted to anion gaps and their interpretation. Basically, anion gaps discussion belong to the part of the lesson that describes metabolic acidosis, which is why the one or two minutes that are spent on the gaps are added to the previous part. However, this knowledge is a separate outcome, which is why it is mentioned specifically.

Anion gaps are the difference between positively and negatively charged ions, and they are used to define the type of acidosis (Habermann & Ghosh, 2008, p. 132). The differences between these types are described above; for students, this part of the lesson logically follows the discussion of the types of disorders. In general, it can be concluded that the lesson’s parts are well-united and are effortlessly connected. However, the distinction between the parts provides the opportunity for the introduction of new activities (for example, lecture followed by brainstorming and then discussion) and the session of questions and answers.

After the final part and the questions of the students, the test is carried out. This form of assessment is chosen for its multifunctional nature: tests can be used to assess the outcomes of learning including the knowledge and skills acquired as well as to support the learning process and even improve the confidence and self-esteem of the students (Douglas, Wilson, & Ennis, 2012; Long, Mitchell, Young, & Rickard, 2014).

Assessment of Learning and Teaching (Justification)

This lesson is very closely connected to the cognitive theory of learning that justifies most of its parts.

Cognitive Theory in Nursing Education

The cognitive theory of learning first appeared to defy the norms of behaviourism and its emphasis on the environment, shifting the focus to the learner, which makes this approach especially relevant for active learning (Mann, 2010; Walters, 2014). It includes the cognitive emphasis on practice and especially active student engagement in the process of learning, which defined the activities chosen for the lesson (Aliakbari et al., 2015; Dubé & Ducharme, 2014). Active learning is any “engaging activity other than that of passively listening to teachers lecture” (Kroning, 2014, p. 448). It is being promoted nowadays as a more effective alternative to the classical teaching (Waltz et al., 2014). There is no common recipe for the active learning activities that should be used in a particular classroom (Moore, 2012; Walters, 2014). The ones that were chosen for this lesson ensure the fulfillment of the learning objectives and take into account the time restrictions.

The need for understanding rather than mechanical repetition was first emphasised by cognitivism as well, which defined the learning objectives of the lesson (Aliakbari et al., 2015). Apart from that, the cognitive theory considers the students unique from the point of view of their abilities and preexisting knowledge, which explains the need for prior knowledge assessment and the definition of learners’ needs (Kay & Kibble, 2016). Finally, the cognitive theory is directly concerned with studying the cognitive processes that allow learning (Kaylor, 2014). As a result, the activities that are aimed at fostering critical thinking (discussions, questions, and answers) as well as memorising the new information (questions and answers and the test) are the result of the application of cognitive theory in practice.

Cognitive and behavioural theories have been united into the social cognitive theory that takes into account environmental and individual learners’ factors (Mann, 2010). It cannot be said that this lesson ignores the environment; in fact, the environment is considered to be an important contributing factor (Marchand, Nardi, Reynolds, & Pamoukov, 2014; Park & Choi, 2014). However, the cognitive approach is more relevant for this particular lesson as it defines the key activities that are aimed at achieving the learning objectives. As a result, I can insist that the learning objectives were achieved through the implementation of the principle of the cognitive theory. The students learned about ABGs and, most importantly, understood the related disorders, and the learning, therefore, took place.

It is also noteworthy that cognitive theory regards self–reflection as an important part of education, which is why the present portfolio can be regarded as a tool that is in line with the theory (Mann, 2010).

Fieldwork Report (Reflection)

Reflective Process (Gibbs Framework)

Reflection is a part of the learning of an educator, and it can be considered the final stage of the learning cycle (Josephsen, 2013). Reflection has always been considered a means of enhancing teaching and learning, and there exists scientific evidence to the fact that reflection assists in developing skills and acquiring knowledge (Dubé & Ducharme, 2014; Fowler, 2014; Josephsen, 2013; Kim & Yazdian, 2014; Velo & Smedley, 2014).

To ensure the success of reflection, it needs to be guided by a suitable framework (Jacobs, 2016). For this reflection, Gibbs’ (1998) framework is going to be used for the following reasons. First of all, it is a valid framework that includes the stages of description, analysis, and conclusions that are necessary for any reflection. Secondly, it focuses on facts as well as emotions and impressions, which makes it holistic. Thirdly, the framework includes the suggestions for future action plans. In other words, Gibbs’ (1998) framework provides the tool for reviewing and analysing an experience, extracting the important ideas from it, and using these ideas (or, possibly, lessons learned) to plan to future actions of similar nature.

Description

Gibbs (1998) insists on describing the events of an experience before attempting to analyse them. This approach helps to reconstruct the events in one’s memory and provide the materials for future analysis. Before the lesson, I had carefully planned it out, including different means of engaging students in the process. I worked to make this process learner-centred. The specific activities included an oral presentation supported by the PowerPoint one, discussion, brainstorming, questions and answers, and the test. All the necessary equipment was prepared beforehand; everything was functioning properly, and we did not experience significant difficulties caused by the environment. In other words, we had sufficient light, the noise level was not distracting, and the classroom was well-suited for the activities, which is all quite important for a successful session (Marchand et al., 2014). I also did not experience trouble in helping the students to learn: many of them were eager, and none attempted to distract others. The knowledge assessment demonstrated a fact that might have contributed to the student’s motivation: their expectations appeared to correspond to the lessons’ objectives, which is most useful for an effective lesson (Haraldseid et al., 2016). The outcomes were measured with the help of questions and test; the questions showed the aspects that the students wanted to discuss, and the results of the test were ranging from acceptable to excellent.

Feelings and Thoughts

I think I was slightly nervous at the beginning; mostly, I was worried about the shortage of time. It is well-known that the lack of time is among the most common barriers to the development of nurses’ competence and to the educational process in general; also, the lack of confidence is not good for an educator’s performance (Cooley & De Gagne, 2016; Pruitt, 2010). However, the time shortage also motivated me, and soon I found that I do not have the time to be nervous. I was very grateful to find that some of the students appeared to be genuinely interested in the topic. In the beginning, I kept thinking about my words, and the fact that there was a possibility of communicative barriers between the students and me made me choose my words carefully throughout the lesson. It was a bit distracting, but I am glad that we did not appear to experience language-based problems in understanding. I was especially happy to discover that none of the students deserved the unsatisfactory mark. In general, I felt that the lesson was largely successful, and it appears to me that I can define the reasons for this success, which will be done in the following section. I am still a bit unsatisfied with the time allocated to the topic, but I am also glad that this restriction made the lesson efficient. I feel like we did not waste a single minute.

Evaluation

After presenting the events and one’ feelings about them, Gibbs (1998) suggests attempting to evaluate them. I believe that the evaluation should be connected to the objective of the course. From the test, it is apparent that students have acquired or refreshed their knowledge concerning ABGs interpretation. Apart from that, it was obvious that a number of learners were interested in the lesson, which, in my opinion, has made it successful.

Analysis

Analysis stage as suggested by Gibbs (1998) requires breaking the whole experience into its components and attempting to explain them.

The preparation stage involved the review of the materials on the topic and the teaching, the planning of the lesson, the creation of the presentation. The knowledge assessment was carried out to define the subsequent actions. It demonstrated that students had some knowledge of ABGs, but for many, it was not systematised, and several students demonstrated the lack of understanding of the mechanisms of ABG interpretation. As a result, the lesson plan did not require too much modification. We did spend more time on metabolic acidosis and anion gaps though since many students were asking questions about them. I think that this decision made the lesson more student-oriented, which is in line with cognitive theory (Mann, 2010).

I suppose that the success of the lesson was defined by the engagement techniques to a large extent. Students were listening carefully, but I made sure that they also contributed to the lesson, and it was the right course of action. While none of them suggested something new, their participation showed that they recognised the logic behind ABGs interpretation. Also, while they did not comment on the methods of teaching, their active participation demonstrated that the chosen activities performed their function. Also, it is known that inactive students may resist active learning methods (Walters, 2014). During this session, we experienced some similar problems, and two of students barely contributed, but overall the participation was sufficiently active that we did not have to go back to lecturing instead of discussion, which I consider a success.

Conclusion

The analysis stage is logically followed by the conclusion that attempts to summarise the ideas that have been gathered from the review and analysis of the experience. The overall experience of teaching turned out to be almost pleasant, and the lesson was very effective. I practice preparing for and carrying out a lesson that is in line with my personal ideas about teaching and modern theories and suggestions for effective learning. Unfortunately, the time restrictions did not allow me to include practical exercises I would like to use for this kind of lesson, but the test rectified this problem to an extent. Also, we experienced the difficulty of active learning methods being avoided by shy students, but the combination of lecture and active learning must have helped this issue to an extent. Besides, the use of supportive visual materials might have contributed. As a result, I believe that I practiced the skill of bringing down some of the barriers to effective learning. I think that together with the students we created this lesson and achieved the learning objectives. Unfortunately, I did not receive much meaningful feedback from the students, and I think that I will explicitly encourage the learners to comment on the methods and techniques employed.

Action Plan

The action plan is devoted to suggesting a plan for the application of the conclusions made. I believe that I need to attempt to incorporate student feedback and reflection despite the time restrictions. Student feedback can be regarded as a source of information on the successfulness of the lesson, and the need for reflection as a part of learning has been described above (Cooley & De Gagne, 2016; Jacobs, 2016; Josephsen, 2013). Also, I suppose that I need to be prepared for less motivated and more inactive students in the future. This experience shows me that the motivation of students is the key to the cocreation of a lesson, which is why I know that I should encourage my students and engage them in the learning process with the help of various methods. This particular experience included the examples of clear goal statement and the opportunities for contributing to the lesson. Having practiced these methods, I plan to apply them in future as well.

References

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