Application of Learning Theories to Nursing Programs

• Evaluate learning theories that are appropriate for nursing programs.
• Behavioral Theory
• Cognitive Theory
• Constructive Theory
• Humanism
• Caring
• Interpretive pedagogies

Learning theories explain the different ways people process information and then retrieve it when needed (Sink, 2008). Learning theories provide ways people respond to and interpret information into cognition (Aliakbari, Parvin, Heidari, & Haghani, 2015). Nurse educators may structure and design courses based on a learning theory or theories (Sink, 2008). Common theories found in nursing programs are as follows:

• Behavioral theory is learning that can be observed when a persons behavior has changed, usually responding from a stimulus (Aliakbari, Parvin, Heidari, & Haghani, 2015).  Behavioral theory is useful when you want a person to receive information, practice it, and then have it reinforced (Sink, 2008). Learning psychomotor nursing skills, such as starting an IV, is an example of using a behavioral theory.
• Cognitive theory is learning that occurs within the mind through the process of understanding, storing and retrieving information (Sink, 2008). Cognitive theory is useful when you want someone to learn how to organize his or her thinking in a way that allows him or her to perform a task (Sink, 2008). For instance, when learning a new concept, the brain finds a way to understand the concept and then retrieve it when needed. Once example would be assimilation, which is associating a new concept to old knowledge then combining into reorganized knowledge (Sink, 2008).
• Constructive theory is when a learner constructs or makes sense of an experience (Sink, 2008). The learner discovers and begins to understand something. Nursing educators can use constructive theory by creating an experience that assists the student to come to a conclusion about what they have gathered, observed, or experienced. Otherwise known as an aha moment where the light bulb in the mind goes on.
• Humanism theory takes learning from a humanistic approach where a person is valued and provided with dignity (Billings & Halstead, 2016). Educators provide learning experiences so that students develop a sense of “responsibility, cooperation, and mutual respect”(Billings & Halstead, 2016, p. 219). The hope is that students learn to be engaged, assume responsibility for their learning, reflect and develop caring behaviors.
• Caring theory is learning to care for people and self through the foundations of morals, ethics, love and valuing (Billings & Halstead, 2016). Learning experiences are geared toward assisting the student to develop into a professional nurse that adheres to nursing philosophies associated with caring.
• Interpretive pedagogies are when learning is discovered and broken down to be understood such as understanding human behavior and experiences (Billings & Halstead, 2016). Students learn to take an experience or story and find meaning within it. This type of theory becomes helpful for students when they are given a mass of information and have to understand it and act on it.

• Differentiate between learning theories used for online, classroom, and clinical modalities and settings.

Several of the same learning theories can be used across different teaching modalities such as online, classroom, learning resource centers, and clinical settings. Behaviorist principles are often seen when faculty structures a situation where steps can be observed, objectives are met, and feedback given (Billings & Halstead, 2016). Constructivist allows the student to take an active role to make sense of something complex, practice it, and organize it into memory. Constructivists allows for new knowledge to build on old knowledge as the faculty member acts as coach and facilitator (Billings & Halstead, 2016). Students can learn by themselves or through interactions with others. In practice learning centers and virtual clinical experiences, simulation-based learning allows for students to apply knowledge, practice skills, critically think, evaluate knowledge and work with others (Billings & Halstead, 2016). In acute and transitional care environments, students practice caring, psychomotor, cognitive and communication while working in a complex environment (Billings & Halstead, 2016). In clinical practicum, faculty needs to create a comfortable environment for students to learn in. Focused clinical learning allows for faculty to design experiences where students can practice their skills (Billings & Halstead, 2016). For distance learning, faculty needs to create a sense of community and be available to students via electronic means.

• Evaluate the analysis, design, development, implementation, and evaluation (ADDIE) instructional design model versus one other instructional design model.

ADDIE Model:

The ADDIE Model is a best practice instructional systems design model that helps educators strategize to choose learning experiences that are not only based on theories but meet individual and program needs (Sink, 2008). The ADDIE Model phases are analysis, design, development, implementation, and evaluation (Sink, 2008). The outcomes of each step are used for the next step. During the analysis phase, the gap in knowledge between a desired outcome and what students already know is recognized and acknowledged. During the design phase, the designer develops “learning objectives, assessment instruments, exercises, and content” (Kruse, n.d.). In the development phase, learning materials are created from the design phase. Students receive materials during the implementation phase that are then evaluated in the evaluation phase for effectiveness (Kruse, n.d.).

Kirkpatrick Model:

Another instructional design is the Kirkpatrick model that consists of four phases known as reaction, learning, behavior, and results (Billings & Halstead, 2016). The Kirkpatrick model uses any type of training and can be used prior to, during, and after training (Kurt, 2016). Reaction phase determines how a person reacted to instruction (Kurt, 2016). Learning phase looks at whether or not instruction was understood, which can be through increased knowledge, skills or experience (Kurt, 2016). Behavior phase determines if a person is able to transfer what is learned through application in their work (Kurt, 2016). Results phase evaluates if what a person learned and applied to work benefited an organization or business (Kurt, 2016). The Kirkpatrick model works best for evaluating and analyzing results (Kurt, 2016). Each phase occurs in subsequent order and measures the effectiveness of the instruction. Each phase takes a relatively long time to obtain and evaluate.

• Evaluate effective instructional methods you plan to incorporate in the program.

Teaching strategies:

Factual knowledge

• Lectures
• Group discussion

Conceptual knowledge

• Debate
• Simulations

Procedural knowledge

• Demonstrations
• Games

Metacognitive knowledge

• Case study
• Reflection

Effective instructional methods that could be used for a program should engage students and involve active learning. According to Billings & Halstead (2016), active and engaged learning increases academic learning, personal development, and improves likelihood of meeting learning outcomes. Faculty should facilitate learning and provide prompt feedback. Bloom’s knowledge dimensions were used as a means for choosing appropriate teaching strategies.

Within Blooms teaching strategies are factual, conceptual, procedural, and metacognitive knowledge (Billings & Halstead, 2016). Within factual knowledge is lecturing and group discussions where basic components of knowledge are obtained (Billings & Halstead, 2016). Lecturing would involve the educator providing information and content in an oral presentation. Oral presentations can incorporate videos, pictures, case studies, and handouts to make them interactive. Discussions among small or large groups of students can revolve around a concept or topic, and can occur in a classroom or online. Discussions lead to student interaction to solve problems and learn from each other.

Within conceptual knowledge are debates and simulation where the relationship between concepts come together and are understood (Billings & Halstead, 2016). Debates allow students to inquire about a topic or problem and form a judgment. Debates teach students to work together, analyze, and recognize complex situations in healthcare (Billings & Halstead, 2016). Simulations allow students to practice skills, critically think, solve problems, and use clinical reasoning in a non-threatening environment (Billings & Halstead, 2016). Simulations vary in realism from individuals practicing on a model to acting out a scenario in groups.

Procedural knowledge is learning how to do something through various techniques, methods, skills, or algorithms (Billings & Halstead, 2016). Demonstrations and games fall within procedural knowledge (Billings & Halstead, 2016). Demonstrations allow students to showcase what they have learned, how they perceived meeting an objective, and portray a process to aid in retention. Demonstrations are interactive and can be evaluated through projects and presentations online or in a classroom. Games are used to reinforce learned knowledge, are interactive and fun, and can be used online or within the classroom. At the end of the game the student can receive immediate feedback.

Metacognitive knowledge is when a student is aware of their knowledge or of cognition (Billings & Halstead, 2016). Case studies and reflection are two strategies found within metacognitive knowledge (Billings & Halstead, 2016). Case studies are given scenarios that depict real life situations that can be analyzed to assess one’s learned knowledge. Case studies can be used in groups, online, and in class. Case studies help students transfer knowledge of theory into practice and allow for active participation. Reflection allows students to review what they have learned and how it relates to given objectives. Reflection can be written in a journal, discussed in a group, online, or in the classroom.

• Evaluate how accrediting standards influence the development of curriculum.

Accreditation Agencies

• Accreditation Commission for education on Nursing (ACEN)
• Commission on Collegiate Nursing Education (CCNE)

Accreditation standards are put in place to ensure institutions provide high quality education that is above or meets national standards. Curriculum must adhere to accrediting standards so that programs can continue to run, receive accreditation, and receive funds. Curriculum needs to keep up with changes that are occurring in healthcare and technology to compete with other institutions and meet student needs. Accreditation standards guide institutions as they continue to make improvements to their curriculum. Two known accreditation agencies that influence nursing program curriculum are the Accreditation Commission for education on Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) (Billings & Halstead, 2016).

Accreditation Commission for education on Nursing (ACEN)

• Mission
• Administrative capacity
• Faculty and staff
• Students
• Curriculum
• Resources
• Outcomes

When ACEN visitors are on site, nursing programs are expected to provide a report of program strengths, processes in development and how they are meeting ACEN standards (Billings & Halstead, 2016). The program should provide evidence that they are meeting standards through course materials, curriculum, resources, faculty information, and student outcomes to name a few. Specifically for curriculum, ACEN requires curriculum that meets professional nursing standards, has well-defined student learning outcomes, and offers various evaluation methods and learning environments (The National Council of State Boards of Nursing, 2017). The ACEN has the authority to deliver accreditation that can lead to funding of programs.

Commission on Collegiate Nursing Education (CCNE)

• Mission and governance
• Institutional commitment and resources
• Curriculum
• Teaching-learning practices

The CCNE is associated with the American Association of College of Nursing (AACN) and provides a voice for public health (Billings & Halstead, 2016). The CCNE is another accrediting agency that ensures the public that nursing programs are providing quality education and that produces successful nurses. The CCNE encourages programs to continually make improvements, be innovative and creative. Programs may exhibit innovation and creativity by imparting several evidence-based learning and teaching strategies into their curriculum. New technology such as simulations and online modules can enhance a program, provide interactive learning, and attract nursing students. Standards and AACN Essential guidelines list outcomes and competencies that nursing program curriculum should achieve (Billings & Halstead, 2016). For example, a baccalaureate-prepared nursing program should adopt AACN outline of content, teaching strategies, values, and competencies (The American Association of Colleges of Nursing, 2019). According to the Commission on Collegiate Nursing Education (2018), curriculum should state learning outcomes that correlate with program mission and goals, provide diverse experiences, allow for practice of new knowledge, incorporate interprofessional collaboration, and be evaluated continuously to improve student outcomes.

References

• Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in nursing education. Journal of Education and Health Promotion, 4, 2. Doi: 10.4103/227-9531.151867
• American Association of Colleges of Nursing. (2019). AACN Essentials: The essentials of baccalaureate education for professional nursing Practice (2008). Retrieved from https://www.aacnnursing.org/Education-Resources/AACN-Essentials
• Billings, D. M. & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
• Commission on Collegiate Nursing Education. (2018). Standards for accreditation of baccalaureate and graduate programs. Retrieved from https://www.aacnnursing.org/Portals/42/CCNE/PDF/Standards-Final-2018.pdf
• Kurt, S. (2016). Kirkpatrick model: Four levels of learning evaluation. Retrieved from https://educationaltechnology.net/kirkpatrick-model-four-levels-learning-evaluation/
• Kruse, K. (n.d.) Introduction to instructional design and the ADDIE model.Retrieved from https://pdfs.semanticscholar.org/9dde/73651c087216677a930f1f5c2df02de6a5f9.pdf
• Sink, D. L. (2008). Chapter 10: Instructional design models and learning theories. ASTD Handbook for Workplace Learning Professionals, 195-212. Retrieved from https://search-proquest-com.contentproxy.phoenix.edu/docview/896136435/fulltextPDF/87FEB5447EAC42B2PQ/1?accountid=35812
• The National Council of State Boards of Nursing. (2017). ACEN compliance with U.S. Department of Education standards for prelicensure nursing education. Retrieved from https://www.ncsbn.org/ACEN_Compliance.pdf