Sam Maceri Sam is the Director of Education

Sam Maceri Sam is the Director of Education and Support. He is responsible for the clinical education of nurses at St. Jude. He received his MSN, Masters in Public Administration and a DNSc from the University of Tennessee. He has served as Director of Nursing, Chief Clinical Officer, and Director of Clinical Services, and Nurse Manager in several different health care institutions, and has extensive experience in management and administration. Sam is a frequent speaker in management development and training programs. 1

Active learning in Nursing Education Samuel L. Maceri, MPA, DNSc, RN, CNAA (BC) Director, Education & Support St. Jude Children’s Research Hospital

What we know • • • We’ve all had terrible instructors We’ve all had excellent instructors. Some people seem to have innate ability to teach Some brilliant people cannot teach at all! Different people like different teachers Developing teaching skills is not easy http: //images. google. com/imgres? imgurl=http: //www. puck. net/Images/muckup/images/DSC 00214. jpg&imgrefurl=http: //www. puck. net/&h=600&w=800&sz=139&hl=en&start=4&tbnid=k. Re. Pi. ZYRp. GEv 7 M: &tbnh=107&tbnw=143&p rev=/images%3 Fq%3 D%2 B%2522 boring%2 Bteacher%2522%26 svnum%3 D 10%26 hl%3 Den%26 lr %3 D%26 safe%3 Dactive%26 sa%3 DX 3

What to we want to know? 1. How to be a good teacher 2. How to get the learner involved 3. How to make important content interesting 4. How to get people to listen to us 5. How to get them to learn. http: //www. homestead. com/Wordkraft/files/210. JPG 4

So using nursing education examples here’s what we will do 1. Describe how adults learn, so that 2. we can teach them the way they learn http: //mh 1. mh. org. au/Nursing. Education/RMH/images/Annual. Report. jpg 5

So, a good teacher of adults is able to describe: 1. Adult learning principles 2. Active/cooperative teaching methods that are based on adult learning (Now, we could have called the above “Educational purpose, ” and “learner objectives” – like we do for so many courses, but would you have paid as much attention? ? ) 6

Well, just how do adults learn? 1. 2. 3. 4. Adults need to know why they need to learn something before undertaking to learn it Knowledge comes from observation and experience rather than tradition and authority Learning improves when the learner is an active participant in the educational process Some stress may increase motivation to learn, but too much anxiety may create fatigue, inability to concentrate, resentment and other barriers to learning. (We could have called these ‘adult learning principles, ” but that would have sounded boring. Besides, It is more fun asking a question and then answering it) 7

So, when planning programs, keep in mind Adults: • Are autonomous and self directed They want to direct themselves and respond well to choices • Have life experience and knowledge Enjoy having their talents and experience made use of in a teaching situation. Need to connect their previous experience to the current Learning. http: //www. nassauboces. org/cte/images/alc_mainpage. jpg 8

So, when planning programs, keep in mind http: //noblenetwork. org/About. Us/images/Girlwithpencil. jpg Adults: • Are goal oriented Usually know exactly what they want to learn • Are relevancy - oriented Must have a reason for learning something. Learning must be applicable to their work • Are practical – mainly want to know what they need in their work Not often interested in knowledge for its own sake – don’t want a lot of theory. Needs are concrete and immediate http: //webhost. bridgew. edu/bkeenan/professional%20 goals. gif 9

So, when planning programs, keep in mind Adults: • Want respect – then need to be treated as equals and allowed to voice their opinions Resent having teachers talk down to them • Are sometimes fatigued by the end of class Appreciate variety, visual aids, change of pace, humor, stretch time, frequent breaks 10

There’s more! Passive = traditional learning Active = cooperative learning (We’ll talk a lot about this one) http: //images. google. com/imgres? imgurl=http: // ecadw. colorado. edu/enotes/oct 05/images/Active _Learning_Fair_092105 HK(3). jpg&imgrefurl=http: //ecadw. colorado. edu/ enotes/oct 05/&h=278&w=305&sz=145&hl=en&s tart=112&tbnid=2 Ay 6 Gnfam 1 KNn. M: &tbnh=106& tbnw=116&prev=/images%3 Fq%3 D%2 B%2522 active%2 Blearning%2522%26 start%3 D 100%26 n dsp%3 D 20%26 svnum%3 D 10%26 hl%3 Den%26 lr %3 D%26 safe%3 Dactive%26 sa%3 DN 11

Let’s compare You remember Active/Passive Example 10% of what you hear Very Passive Verbal lecture 30% of what you see Passive with Visual Aids 50% of what you watch, see and hear Beginning to get active Interactive the most you can get during a "lecture" class 70% of what you figure out and do Active presentatio n experiential learning 90% of what you figure out and verbalize Very Active The student explains Study Groups and Tutoring The beginning of Mastery Most "Standard" Lectures Downloaded 11/16/06 from: http: //lpc 1. clpccd. cc. ca. us/lpc/hanna/learning/activelearning. htm 12

Caution! Part of the learning challenge is to avoid the misconception that if we have made a ® ® presentation on Microsoft Power Point and think that we have put together an exciting presentation. An electronic presentation can be just a traditional lecture using electronics as visual aids – no better – with the same limited effectiveness http: //images. google. com/imgres? imgurl=http: //www. guidebookgallery. org/pics/splashes/po werpoint/4. 0. png&imgrefurl=http: //www. guidebookgallery. org/splashes/powerpoint&h=317& w=520&sz=19&hl=en&start=115&tbnid=er 6 a 7 GDAYrnh. KM: &tbnh=80&tbnw=131&prev=/im ages%3 Fq%3 DPower. Point%26 start%3 D 100%26 ndsp%3 D 20%26 svnum%3 D 10%26 hl%3 Den %26 lr%3 D%26 safe%3 Dactive%26 sa%3 DN 13

Cooperative Learning Incorporated in all education offerings – fosters: – higher-quality reasoning strategies – more frequent transfer of these from the group to individual members – more new ideas and solutions to problems – more intrinsically motivated, intellectually curious, caring of others (2004, Learning Point Associates) 14

Cooperative Learning But what is it? Cooperative learning is a successful teaching strategy in which small teams, each with students of different levels of ability, use a variety of learning activities to improve their understanding of a subject. Each member of a team is responsible not only for learning what is taught but also for helping teammates learn, thus creating an atmosphere of achievement. Cooperative learning is also relatively easy to implement and is inexpensive. http: //www. ed. gov/pubs/OR/Consumer. Guides/cooplear. html 15

Cooperative Learning But what is it? – another answer Cooperative learning is the instructional use of small groups so that students work together to maximize their own and each other's learning. Considerable research demonstrates that cooperative learning produces higher achievement, more positive relationships among students, and healthier psychological adjustment than do competitive or individualistic experiences. http: //www. ntlf. com/html/lib/bib/cooplearn. htm 16

Use any internet search engine and enter, “Cooperative Learning. ” You will get a lot of resources Let’s look at some of the most common ones: – – KWL Think Pair Share Anticipation Reaction Guide Case Studies 17

Let’s look at a few cooperative learning methods that work. 1. KWL • K – What the students already KNOW (Remember we said that adults “have life experience and knowledge” • W – What the students WANT to know (Remember we said that adults “are autonomous and self directed” and “are goal directed n know exactly what they want. ” • L – Did they learn it 18

KWL - How can I do it? • On the board, on an overhead, on a handout, or on students' individual clean sheets, draw three columns. • Label Column 1 K, Column 2 W, Column 3 L. • Before the presentation, reading, video, etc, students fill in the ‘Know’ column with everything they already know about the topic. This helps generate their background knowledge. • Have students put in the middle column what they want to learn about the topic. • After the learning exercise, students should fill in their new knowledge gained from reading the content. They can also clear up misperceptions about the topic which might have shown up in the ‘Know’ column before they actually read anything. Did they get it or not? http: //olc. spsd. sk. ca/DE/PD/instr/strats/kwl/ We did a version of KWL with this presentation 19

http: //olc. spsd. sk. ca/DE/PD/instr/strats/kwl/ 20

KWL Possible additions to chart and/or topics for discussion: • What we think we know, but aren't sure about • What's our evidence for what we know • How we might find out what we want to know (what would be evidence? ) • What could we find out by interacting with or observing the materials/phenomena, rather than by reading or asking experts? • What questions do we still have? http: //images. google. com/imgres? i mgurl=http: //web 2. uvcs. uvic. ca/enc omium/writingdemo/wa/images/q_ marks. gif&imgrefurl=http: //web 2. uv cs. uvic. ca/encomium/writingdemo/w a/wt/wt_04. htm&h=150&w=150&sz =4&hl=en&start=69&tbnid=k 3 i. Ow. L _sq. AEJVM: &tbnh=96&tbnw=96&pre v=/images%3 Fq%3 Dasking%2 Bque stions%26 start%3 D 60%26 ndsp%3 D 20%26 svnum%3 D 10%26 hl%3 Den %26 lr%3 D%26 safe%3 Dactive%26 s a%3 DN http: //olc. spsd. sk. ca/DE/PD/instr/strats/kwl/ 21

Think – Pair - Share • • Teacher poses a problem or asks an open-ended question to which there may be a variety of answers. Teacher gives the students ‘think time’ and directs them to think about the question. Following the ‘think time’ students turn to face their Learning Partner and work together, sharing ideas, discussing, clarifying and challenging. The pair then share their ideas with another pair, or with the whole class. It is important that students need to be able to share their partner’s ideas as well as their own. http: //www. eazhull. org. uk/nlc/think, _pair, _share. htm 22

Think – Pair – Share Emphasizes the experience adults bring to any learning situation, and respect and helps them become active participants. http: //www. bced. gov. bc. ca/irp/cfrench 512/images/smiley. gif 23

Anticipation Reaction Guide • An Anticipation/Reaction Guide uses a twin strategy to increase comprehension: stimulate prior knowledge and experiences before an educational activity and then reinforce key concepts after the activity. • The guide presents students with a series of leading questions to be answered in writing before the educational activity. • Students then share their answers in a class discussion designed specifically to "activate, or better "reactivate, " prior knowledge. Adapted from http: //www. justreadnow. com/strategies/anticipate. htm 24

• Students attend the session then evaluate their written answers (prior knowledge). Students should note when their answers agree or disagree with the text's content. • Finally, students engage in a summarizing discussion, expressing how the activity reinforced or challenged their prior knowledge. 25

Anticipation Reaction Guide Steps to Constructing and Using Anticipation Guides: • Outline the main ideas of your video/presentation, etc. . Write the ideas in a short list (no more than 5 or 6 points), using clear declarative statements. • Rewrite the main statements in the form of questions to prompt the students' prior knowledge and to elicit student reactions and predictions. • Have students write responses to each of the questions. 26

• Allow students to openly discuss their answers/predictions prior to reading/viewing/attending activity. Note any recurring themes in the discussion. Also, note any opposing or contradictory points of view. • Have students view the video or attend the educational activity. Instruct students to make comments on their written answer sheet, noting agreement and disagreement between their answers and the author's message or purpose. • Encourage open discussion of these comments. Chart common themes of agreement and disagreement. Focus especially on student ideas and attitudes that change during the reading. 27

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Jig saw groups http: //globalconnect. ucsd. edu/images/logos/jigsaw. gif 29

Jig Saw. Expert group 1 1 Jig-saw group 1 1 2 2 2 1 2 3 3 3 1 3 2 30

Case based learning “Cases put students in an active learning mode. In other words, cases invite students to do things and to think about the things that they are doing. In effect, cases present students with opportunities to analyze and solve real-world practical problems. Cases challenge students to test what they learn through practice instead of merely testing their memory” Retrieved from the WWW, November 20, 2006. http: //www. schreyerinstitute. psu. edu/pdf/Case. Writing. Guidelines. pdf http: //serc. carleton. edu/images/introgeo/icbl/storyteller. jpg 31

Case based learning 1. 2. 3. 4. 5. Generate a list of the concepts you want the students to understand (e. g. . Foot care for a diabetic) Develop a case (perhaps synthesizing a collection of real cases) – that realistically and accurately reflects the content. (Recall a diabetic patient or patients that had difficulty with foot care) Present the case (describe a real or fictitious patient with foot care education needs) Propose questions that help them address the content. (e. g. What hygiene instructions would you give a newly diagnosed diabetic? ) Teach them more detail. (e. g the pathophysiology of impaired peripheral circulation in diabetics and the consequences of improper hygiene) 32

Case based learning To increase effectiveness of case based learning, the case must be presented FIRST, so that the learners actively draw out the information from the case. Many instructors present information first and then use a case to illustrate the information after the information is presented. 33

• This was an overview if a few of the techniques for active and cooperative learning. By entering those terms in any internet search engine, you will find a wealth of helpful information. • We hope that these tips will help you transition from traditional learning to more active learning, thereby enhancing the learning potential of those who depend on your guidance “We wish you well in the noble challenge of engaging and energizing those who work so hard to provide good nursing care. ” Samuel L. Maceri 34

References/Bibliography Alspach, J. (1995). The educational process in nursing staff development. St. Louis, MO: Mosby. Avillion, A. , ed. (2001). Core curriculum for staff development. Pensacola, Fl: National Nursing Staff Development Organization. Lowenstein, A. , and Bradshaw, M. (2001). Fuszard’s innovative teaching strategies in nursing. Gaithersburg, MD: Aspen. Ulrich, D. , and Glendon, J. (2005). Interactive group learning, 2 nd ed. New York: Springer publishing Company. 35