Principles Of Teaching

Identify the problems and challenges presented in the video and discuss how you would respond to and handle the problems and challenges from 1) the faculty role 2) the RN preceptor role, and 3) the student role.

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Educational Philosophy
I am not new to the role of nurse or educator, but to the role of nursing educator. My motivation to teach future generations of nurses prompted my transition from a clinical nurse to an academic nurse educator. My interest in teaching comes from my own positive experiences as an undergraduate student and from a love of learning. My educational philosophy is a work in progress as I continue to grow as a nurse, educator, and scholar of nursing education. As a novice nursing educator today, I plan on progressing to the path of an expert. The purpose of this paper is to express my educational philosophy in terms of teaching and learning, teaching and learning strategies, student learning goals, and the learning environment.Principles Of Teaching And Learning Nursing Essay
Teaching and Learning
I believe in a cooperative learning pedagogy where teachers guide students’ education and stimulate them to think critically, analyze complex situations, and problem solve. Learning is a lifelong partnership between both teacher and student. There has to be mutual respect and a common goal to facilitate learning. Therefore, students must agree to take responsibility for their learning in order to engage and teachers must be willing to engage. My role as a teacher is to assist students through evidence-based practice, scholarly inquiry, and research.
Learning is on a continuum that does not stop but constantly changes and develops for both teachers and students. Learning is more than memorizing facts; it is about

Teaching and learning in the clinical context
Author:
Dr Linda Hutchinson MB BS, MRCP, DCH, MSc
Director of Education and Workforce Development
University Hospital Lewisham
London
This paper was first written in 2003 as part of a project led by the London
Deanery to provide a web­based learning resource to support the
educational development of clinical teachers. It was revised by Judy
McKimm in 2007 with the introduction of the Deanery’s new web­based
learning package for clinical teachers. Each of the papers provides a
summary and background reading on a core topic in clinical education.Principles Of Teaching And Learning Nursing Essay
Aims
This paper:
· Provides some ideas of how to make the most of clinical scenarios
when teaching students or trainees
· Raises awareness of the relevance of theories of learning and teaching
to clinical contexts
· Enables you to identify aspects of your everyday work which can be
used as evidence for CPD
Learning outcomes
After studying this paper, you will be able to:
· Identify opportunities for teaching and enabling learning in everyday
clinical practice
· Apply some of the major theories of learning and teaching from Higher
Education and healthcare contexts to your own teaching practice
· Develop a reflective approach to teaching and learning which you can
utilise in your own continuing professional development
Content
Introduction
Educational theories:
· Behaviour theory
· Cognitive theory
· Humanism and adult learning theory
· Situated cognition and the transfer of learning
Application of learning theories
This paper provides an overview of teaching and learning in the clinical
context, considers theory and practice. It provides an overview of some
educational theories, explains how these have impacted on teaching
practice and offers ideas for putting theory into practice in the clinical
context with a view to creating good situations for learning.
There is a complementary paper Facilitating learning: Teaching and
learning methods which focuses on the ‘tools of the trade’: looking at
some of the main teaching and learning methods that clinical teachers
might use.
Introduction
Healthcare has as many ‘contexts’ as you could wish to find. Teaching
and learning could be happening in a frantic emergency unit, in a
children’s clinic, in a primary care facility, in a dentist surgery, on
outreach nursing visits, in a community pharmacy and on and on and on. Principles Of Teaching And Learning Nursing Essay
It is difficult to come up with ‘rules’ of teaching that will fit all possible
situations.
Maybe the best approach would be to look at some general principles for
learning, a range of theories and approaches that can be picked and
mixed to suit the given situation. There is not a right or wrong way to
teach or to learn. To paraphrase Michael Eraut’s recent comments on the
generalisability of research, instead of talking about right and wrong, we
could talk about the conditions under which a given approach is most
likely to work (2002).
If ‘learning’ is the acquisition of new knowledge, skills or attitudes, then
teaching is providing the opportunity for that to happen. Educational
theorists have tried to describe the processes by which learning occurs.
Educational theories
Behaviour theory
Educational theory as we know it started with Pavlov and his colleagues.
Whether using dogs, pigeon, rats, or, unbelievable to consider now, young
children, they worked on the idea that if you repeated the same stimulus
enough times and gave a negative reinforcement (eg. electric shock) or
positive reinforcement (eg. food) for incorrect and correct action,
eventually your subject would ‘learn’. This is known as behaviour
theory. Before we dismiss it completely, a couple of things originating
from behaviour theory still stand today. Firstly reinforcement or
punishment and reward continue in use, although it is more politically
correct to call them feedback, and to use positive rather than negative
approaches.
Secondly, breaking tasks down into small steps. When the rat was
‘taught’ to negotiate a maze to get the food, small bits of the maze were
‘learnt’ before going onto the next bit and finally the whole maze. We
teach clinical skills by breaking them down into steps, and each step and
the whole rehearsed.
What the behaviourists gave us:
· Activity aids learning
· Repetition and practice aids learning
· Small steps aid learning
· Reinforcement aids learning
Cognitive theory
In the middle of the 20 th century it became more sophisticated, with
cognitive theory. The age of radio and electrical goods, especially the
computer was influential here. The theorists of the time said we learn by
receiving information, processing it, storing it and retrieving it; a
transmitter radio model. Teachers needed to ensure each step was
optimised. Reducing extraneous ‘noise’ to allow the main message to be
the one that was heard; making sure people were ‘attending’ so that the
message would get through. Processing the information meant repeating  Principles Of Teaching And Learning Nursing Essay
it, using it, trying a number of formats. From this comes the idea of
giving a piece of information, then getting a class or group to work
through examples. Feedback is an integral part of cognitive theory,
similar to the reinforcement of behaviourism.
Storing information for later retrieval is assisted by the processing
mentioned above. The notion of surface, strategic and deep learning is
familiar to most people. Surface learning is storing lots of information in
short­term memory to regurgitate in an examination or immediate
setting. Strategic learning allows the subject to ignore the bits that are
not anticipated as required, and focus on those that are. Again often
assessment driven, but even in the real world, if you attend a lecture or
presentation you only listen to the bits that you think are relevant to your
life or work and make sense within it.
Deep learning is facilitated by being encouraged to understand the
background, the basic elements that lead to the whole concept. It
assumes learning will be banked in long term memory store as it has been
learnt, examined, digested, reprocessed, understood.
Surface learning has a bad reputation, deep learning a good one and
strategic is frowned upon but acknowledged as a survival tactic. Yet all of
us employ each of these in our everyday life. And deep learning is not the
whole answer. I once knew how to use calculus. I practised it in a
number of ways, knew the history of its development and discovery, loved
maths and did well in exams. My learning could not have been deeper, but it has long been inaccessible in that long term memory bank. Absolutely no chance of recall now. Even deep learning needs regular use
in order to keep it.
Although predominantly concentrating on the teaching, the cognitivists did
acknowledge that individual learners had different styles. A number of
inventories are now available to allow individual or group learning styles
to be qualified.
In the table below, we can see how learning processes can be linked to
instructional events that the teacher can facilitate. The first two columns
show stages from Gagné’s instructions for learning – taken from The
Conditions of Learning and Theory of Instruction, 1965. The last column gives possible examples relating to clinical teaching and
learning situations.
Learning Process Instructional Event Examples
Attention; Alertness gaining attention present case study,
clinical photograph
Expectancy informing learner of
the objective;
activating motivation
explain outline of
session and why it
might be important
Retrieval to Working
Memory
Stimulating recall of
prior knowledge
Review previous
session, or set task  Principles Of Teaching And Learning Nursing Essay
that allows audience to
share existing
knowledge
Selective Perception Presenting the stimulus
material
Give short talk on the
main topic
Encoding: Entry to
Long Term Memory
Storage
Providing learning
guidance
Go over topic in more
detail, emphasising the
main messages
Responding Eliciting performance Set exercises that
allow audience to go
over the above, working through
examples
Reinforcement Providing feedback;
assessing performance
Give feedback on the
exercises above
Cueing Retrieval Enhancing retention
and transfer
Summarise main
points; give handout
with further reading
See the Curriculum development paper, Aims and learning outcomes
section for more information on learning and learning styles.
What the cognitivists gave us:
· Learning comes from understanding
· Organisation and structure of teaching aid learning
· Perceptual features need attention
· Cognitive feedback aids learning
· Individual differences need to be taken into account
Humanism and adult learning theory
By the 1970s and 80s the individual became more important. Carl
Rogers, Malcolm Knowles and others said adults are different to children.
They have experiences, prior knowledge, personalities. They will learn if
we provide a secure, motivational environment, in fact, they cannot help
but learn as it is a natural human instinct. The role of the ‘teacher’ is to
facilitate the learning, not to be the fountain of all knowledge. Make it a journey of self discovery said Maslow, albeit talking about
psychological development and human motivation.
Let’s reflect, hold up the mirror so that people can think about their
actions and learn from and for themselves, said Kolb. Look at the
Teachers toolbox item Learning theories which provides more information
about theories of how people learn and what this means for teachers. Principles Of Teaching And Learning Nursing Essay
The strong emphasis on reflective practice, so much a part of nursing
education, is based on these premises. The reflection that is necessary to
turn an event into a concrete experience is more than remembrance. It is
an analysis using a structured process to review the knowledge and skills
used during the event and, probably more importantly, any gaps and
learning needs that were identified. What the humanists gave us:
· Learning is a natural process
· Motivation, purposes and goals are important · Social situation affects learning
· Choice, relevance and responsibility aid learning
· Anxiety and emotion affect learning
Situated cognition and the transfer of learning
In a seminal paper in 1989 Brown and colleagues questioned the idea of
learning being transferable. You teach a child the 4 times table, he or she
can recite it fantastically, but take them to the shops and say you need
four packets of sweets at 8p each and nothing. Or the converse situation:
the child who helps his or her parents in the shop at weekends and can
multiply up prices by the units of items in a box, number of boxes, and so
on, but put a pencil and paper in front of them and ask them to do the
sum, and they struggle. My personal example is that I went to the talks
on how to manage haematuria in children, I read the books, I
regurgitated for exams, but come the clinic and the child in front of me
and I had to start again. Once I had seen a few children presenting like
that it was easier. The learning had to be situated in my life context to
have any meaning and to stick. Situated cognition has many implications
for transferring classroom­based learning into the real world. And even in
the workplace, knowing something in one context may not mean you
‘know’ it in another.
Importantly, this makes teaching and learning in the real world context
the most meaningful even if it is constrained by practicalities and the
tensions of delivering service. Although the apprenticeship model is open
to abuse, it is intuitively the right model and should be the basis of all
health care professions’ education. As we get pushed further into the
world of simulations and models, it is worth remembering the limitations.
Application of learning theories
Enough theory.
How does that help?
I find it useful to take bits of each of the above and consider how we can
create a good situation for learning. Regardless of the clinical context any
or all of these can be adapted.
Step 1 – get the environment right (humanism/adult learning)
Regardless of what you want to teach and what the person wants to learn,
it is vital to create a positive learning environment. The most important
teaching technique is the one least planned – role modelling. As a
teacher, you should model good behaviour, clear boundaries, you should Principles Of Teaching And Learning Nursing Essay
motivate and enthuse by understanding the learners’ perspectives. This
can be difficult when you know there are factors outside of your control
that will potentially demotivate, but a teacher who provides an
atmosphere of enquiry, free of condemnation or ridicule is a good one
whatever the circumstances.
Simple measures may be needed – opening the windows in a stuffy room, stopping for a break when everyone starts to flag, leaving time at the
beginning to find out what the students expect and want, at the end for
final discussion and questions, all show that you are thinking of the
students.
Other measures show that you value them. Being genuinely interested in
their accounts, their questions and the reasons behind them, using their
experiences and their prior knowledge to build the session. Certainly
avoidance of anxiety and distress is essential.
Step 2 – who are the learners (cognitive and humanism)
This is not an excuse to stereotype medical students or the nursing
students, but finding out what they know, what their experiences are, etc.
There is not often enough time for detailed research before a teaching
session and we can all recall times when we thought we were to teach one
group and it turned out to be a group at a different level.
Step 3 – what do you want them to know/do by the end and to what
level? (behavioural and cognitive)
Here are the good old objectives. It gets boring to repeat (and to do, lets
be honest) but time spent on getting the aims right, with or without the
students’ input, allows the correct selection of teaching methods. Is it a
rote based task, eg. basic life support, that needs a drill, needs breaking
down into small steps, repeating, repeating, repeating. Or is it an ethical
awareness with no right or wrong answers that requires exploration
through discussion, allowing students to generate their own viewpoints
based on their previous experiences. Even though potentially extreme,
and certainly more time consuming than a one way lecture, it allows the
whole group to see the breadth of views and accommodate differences in
opinion.Principles Of Teaching And Learning Nursing Essay
Step 4­7 – prepare, prepare, prepare, prepare (behavioural and cognitive

mostly, but also humanism)
The tension between delivering the service and teaching is always evident,
and when the former is under pressure the latter is forgotten. Asking
busy clinicians from whatever profession to teach, take students,
supervise trainees, etc is difficult enough, suggesting they then spend
time preparing each day results in laughter.
Step 8 – Feedback and reflection (all)
Not just giving feedback to the students and allowing them to reflect on
their learning, but also feedback and reflection on your role as a teacher. What did you as a teacher learn from this?
Go through the evaluation results, ask a colleague to observe and
comment on your teaching. Even a ‘good teacher’ can get better.

NOW

Education encompasses specific skills of teaching and learning, and also the imparting of knowledge, good
judgment, and wisdom. Education strives to close the gap between knowledge and practice, for the ultimate purpose
of increasing quality of care for the population served.
This paper addresses the issue of the gap between theory and practice in the nursing profession. It is important to
reflect on the terms theory, practice, and the gap between the two terms. Theory as defined by the dictionaries is a
set of statements or principles devised to explain a group of facts or phenomena, especially one that has been
repeatedly tested or is widely accepted and can be used to make predictions about natural phenomena. The term
practice is defined as the act or the process of doing something; performance or action. In definition these terms
appear to be at odds with each other but when considered in terms of professional setup they have to enable the
application of ‘applying the theory into practice’.Principles Of Teaching And Learning Nursing Essay
Nursing is considered as caring for a person in a variety of health related situations. This caring also involves
teaching about health and the prevention of illness; hence, nurses play a key role in promoting higher standards of
health. To maintain a proper balance between theory and practice, a nurse, has to be updated with current knowledge
and practice in the field.
If all the nurses are placed with competence in theory and practice forming the either ends of the continuum most
nurses are likely to find themselves at the either ends of the continuum. There is evidence to suggest that nurses who
are proficient in theory are able to write the best care plans, discuss pathophysiology, treatment rational, etc,
* Khairulnissa Ajani. Tel.:+92-21-34865409; fax: +92-21-34146880.
E-mail address: khairulnissa.ajani@aku.edu
Open access under CC BY-NC-ND license.
Open access under CC BY-NC-ND license.
3928 Khairulnissa Ajani and Salima Moez / Procedia Social and Behavioral Sciences 15 (2011) 3927–3931
2
however, they struggle with hands on practice. On the other hand, nurses who exhibit strong clinical practice skills
often find it difficult to rationalize the care in terms of theory. Their knowledge of Pathophysiology and
pharmacology needs to be strengthened.
This theory practice gap has been widely addressed in the literature issue has been given both positive and
negative meanings and justifications in the literature. It has consequences for the professional status and image of
nursing. It affects the perceptions and impressions to the patient and other members of the team about the nurse. It
also affects the evaluation that a nurse undertakes for the purpose of promotion and professional development.
This theory-practice gap has other influences on the nursing profession related to motivation and dignity of work.
If nurses are not well equipped theoretically, the image of nurses being doctors’ hand maidens is promoted. On the
other hand, if they do not exhibit proficient hands on skills, their credibility is questioned, leading to frustration and
de-motivation.
There are several factors responsible for promoting theory practice gap in nursing:
x The apprenticeship model
x Students being used as service providers
x Lack of current clinical practice amongst nurse educators
x Governmental support
x Support from the governing bodies in nursing
x Research in nursing Principles Of Teaching And Learning Nursing Essay
x Lack of opportunities for continuous education
The perceived problem of the knowledge and practice gap is built upon the assumption that theory can and must
be directly applied to nursing practice, otherwise it is irrelevant. The type of knowledge associated with practice
could be taught through theory and must be well represented in theoretical terms. Much has been written in other
countries regarding the theory practice gap in nursing which include the discrepancy between what is taught in the
classroom and how care is actually given in practice however almost nothing has been written in the context of
Pakistan.
2. Literature review:
The theory-practice gap is widely addressed in the international literature. Knowledge and practice issues have a
long-standing history in nurse education, and are a chronic source of controversy to which there is no easy or perfect
solution (Hewison, A & Wildman, S., 1996). This tension between theory and practice and research which can be
usefully exploited in teaching and research (Rafferty, Allcock, & Lathlean,1996).
Emphasizing the importance of the issue (Rolfe, 2003), states that the theory- practice gap is felt most acutely by
student nurses. Student may find themselves torn between the demands of their tutor and the practicing nurses. They
are faced with real clinical situations in which they are unable to generalize from what they have learned in theory.
The discrepancy between nursing as it is taught in the classroom and nursing as it is practiced by students in the
clinical setting has long been a source of concern to teachers, practitioners, and learners worldwide. Despite
considerable efforts by the profession to bring about change, the basic problems identified in 1976, by Bendal,
continues to cause concern. (Bendal,1976) cautioned nurse educators about producing nurses who were
“increasingly proficient on paper and decreasingly proficient in practice. She had also cautioned that what nurses
were learning in theory was becoming increasingly divorced from what they were actually doing in practice.Principles Of Teaching And Learning Nursing Essay
If the theory-practice gap is not minimized, it can cause difficulties because the principles of practice established
in curricula are not well aligned with the principles operating in the workplace.
Khairulnissa Ajani and Salima Moez / Procedia Social and Behavioral Sciences 15 (2011) 3927–3931 3929
This difference in philosophy can be problematic for a new graduate, which, in the extreme, may cause them to
leave the profession prematurely. To enable students to link theory and practice effectively, certain steps need to be
taken. Students need to be introduced to the debates surrounding the genesis and the generation of nursing
knowledge. They need to gain an appreciation of what counts as nursing knowledge at different points in time, and
the politics which drives the legitimization of nursing theory and practice. Such an approach will help nursing
students deal with reality shock and make sense of their experience as they confront the ambiguities, uncertainties,
and contradictions that characterize the stock-in-trade of professional life. Accordingly, the nurse educators should
constantly strive to ensure that theoretical content is designed to adequately prepare graduates and so avoid, or at
least minimize, ‘reality shock’ (Kramer, cited by Garbett, 2002).
Analyzing the issue in the light of the literature three versions of the problem can be highlighted. One is related to
the ‘practice’, which fails to live up to theory (Cook 1991, as cited in Allmark, 1999). This includes the discussion
on how to make nurses more research minded and get them into evidence based practice rather than performing the
skills in the ritualistic, robotic ways. The second version is where the theory is not relevant to the practice, and what
is taught in the idealistic environment of the classroom may not be applicable in the real practical situation. The last
version talks about the gap, which highlights a relational problem between the school of nursing and the hospital
area or the clinical placement. The critical question here is how to make theory more relevant to the practice so that
the gap between the two is minimized. (Scott, 1994 as cited in Allmark, 1995).
The irony of the debate lies in the fact that in nursing, which is a practice discipline, theory and practice cannot
be separated. Knowledge and practice cannot be separated, as both are very critical to any professions is its ability to
grow and change as the world changes. Another positive approach is also mentioned in (Rafferty, Allcock, &
Lathlean, 1996) state that the theory/practice gap can never be sealed entirely; they are by nature always in dynamic
tension, and this tension is essential for change to occur in clinical practice. This tension, seen from a positive point
of view can motivate nursing professionals to work on the issue, it also provides room for avoiding stagnancy in the
profession.Principles Of Teaching And Learning Nursing Essay
3. Recommendations
This now brings us to the point where some solutions should be highlighted. The literature has given a few
solutions, which includes the suggestion by (Brasell & Vallance, 2002), who state that a major challenge to the
nursing profession is to find ways of merging theory and practice in the delivery of nursing education and patient
care. One option for achieving this goal is for nurse educators to spend time in clinical practice; updating their
clinical skills and re-experiencing the realities of practice. Criteria for assessing both written work and performance
on practical placements should also incorporate evaluation of the degree to which the student has integrated
theoretical learning with practical experience. Many authors have suggested that integration will only be achieved if
the staff members responsible for classroom teaching are closely involved in clinical supervision of students
(Edwards, 2002).
Another recommendation is recruiting joint appointments from the area of practice. Also intermittent periods of
clinical update in practice and work role exchanges between educators and clinicians can be utilized by the
profession. This model of clinical practice/education exchange involving two people, one in clinical practice and the
other in education, who exchange jobs for a fixed period of time, is a relatively new concept. The aim of this model
is enhancing student learning and facilitating meaningful links between theory and practice for them. Hence, the
exchange occurs between the education institute and the service area where students are placed. Also, this model
enables the faculty has a responsibility to update themselves with the current changes in health care, through regular
faculty practices; and if faculty is clinically and theoretically competent then he/she would be able to produce
competent students, and in return, the community and country will benefit from the nursing services.Principles Of Teaching And Learning Nursing Essay
The curriculum team also needs to consider the potential influence of the hidden curriculum on the learning
process. Students should be prepared for the, inevitably, conflicting philosophies of nursing in the classroom and the
3930 Khairulnissa Ajani and Salima Moez / Procedia Social and Behavioral Sciences 15 (2011) 3927–3931
reality of the clinical environment. This may serve to reduce anxiety in students and help them work more
effectively with the discrepancies (Landers, 2002).
According to (Ward & Wright, 2004), after identifying a need to develop the knowledge and skill of health care
professionals in palliative care, a specialist team from a primary care trust set up a fast-track training programme.
This consisted of an academic module, a four-week secondment to palliative care settings and a project undertaken
in the workplace to bring about a change in practice. The programme proved successful in increasing the students’
skills and confidence and in changing practice in the workplace.
Goodfellow, (2004) has forwarded the suggestion that to build the research and practice gap it is imperative that
nursing students learn to use research as a basis for making clinical decisions. The author discusses how a journal
club was structured and designed to promote evidence-based practice, and to reduce several of the barriers in
utilizing research in the clinical setting.
Schools of Nursing can adapt the current models of teaching and learning which promote the self directed
approach and the problem-based learning approach. These modes of curriculum enhance critical thinking in the
students and make them more independent. The assessment criteria of the curriculum can also integrate case based
scenarios and practical example so that theory is tied up with the practice.
There is a need to consider continuing education and in-service education programs for nurses to enable them to
stay current with the changes in health care practices. Due to the advancement in technology there is more need that
change in nursing practice should initiate with change in the educational curriculum of the nursing programmes.
Thus, the nursing faculty should initiate change in the curriculum with a focus on changing and improving nursing
practice.
Rafferty, Allcock and Lathlean, (1996) have made very comprehensive recommendations under three headings,
which include reconstructing resources, reorganizing training, and reconstituting roles. Under reconstruction of
resources, it is suggested that clearer boundaries be defined between students and staff nurses and the nursing
assistants. The notion of ‘service is equal to education’ cannot be nurtured further. This means that students should
not be used as service providers; they have their own objectives to meet and studying to be done and, therefore, their
role has to be defined separately from the staff nurses. In re-organizing training it is suggested that the concept of
‘nuns becoming teachers’ have to be modified. Anyone and everyone cannot become a teacher. In order to provide
exemplary education, students have to be taught by qualified and specialized educators. The last point of
reconstructing roles talks about hiring joint appointees and academicians working as clinicians as well which has
been talked about earlier.Principles Of Teaching And Learning Nursing Essay
4. Conclusion
Thus, overall, it is quite evident that the gap does exist and has its strengths as well as areas that can be improved.
There are strategies available to overcome this issue, which focus on the revision of the curriculum and having a
liaison between the education and the practice areas. In the educational setting, as well as the clinical setting, the
leader and the follower will make the operational plan of this suggested model and connect it to the benefits, so that
the profession of nursing is benefited at large.  Principles Of Teaching And Learning Nursing Essay

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