THE UNIVERSITY OF ZAMBIA

INSITITUTE OF DISTANCE EDUCATION

BACHELOR OF SCIENCE IN NURSING

NURSING EDUCATION (NRS 4330)

MODULE: NURSING EDUCATION

May 2012

Developed By Marjorie Kabinga-Makukula

Copyright
©All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic or mechanical, including photocopying, recording
or otherwise without the permission of the publisher.

Error! No text of specified style in document.

August 2011
PO Box 32379
Lusaka
Zambia
Fax: +260 211 290719 Tel :+260 211 290719
E-mail: ide@[Link]
Website: [Link]
Acknowledgements
The University of Zambia (UNZA), Institute of Distance Education (IDE) wishes to thank Mrs.
Marjorie Kabinga-Makukula who contributed to this Nursing Education Module.
 BACHELOR OF SCIENCE IN NURSING

Contents
About this Module Medical Nursing Module
How this Nursing Education Module is structured .................................................................... 5

Course overview
Welcome to the Bachelor of Science Nursing degree: Nursing Education Module ................. 6
Is this course for you? ................................................................................................................ 6
Course outcomes ........................................................................................................................ 6
Time frame ................................................................................................................................. 7
Study skills ................................................................................................................................. 7
Need help? .................................................................................................................................. 8
Assignments ............................................................................................................................... 8
Assessments ............................................................................................................................... 9

Getting around this Nursing Education Module

Margin icons ............................................................................................................................. 10

Unit 1
Unit Title Issues, Trends and Philosophy In Nursing Education……………………………11
Introduction …………………………………………………………………………….........11
First topic: Issues and trends affecting Nursing Education and Practice……………………...........12
Second Topic: Formulating a philosophy of nursing education ..............................................13
Unit summary………………………………………………………………………………..15

Unit 2
Unit Title:Theories of Learning…………..……………..……………………………………16
Introduction:………………………………………………………………………………….16
First topic: Behaviourist approach to learning …..…………………………………………...17
Second topic: Cognitive approach to learning ……………………………………………….20
Third Topic: Constructivist Theories …….………………………………………………......21
Fourth Topic: Humanistic approach to learning……………………………………………...22
Unit summary:………………………………………………………………………………..29

Unit 3
Unit Title: Educational Objectives …………………………………………………………30
Introduction…………………………………………………...…………………………….30
First topic: Background………………………...……………..…………………………….30
Second topic: Taxonomy of Educational Objectives…..……………………………………32
Unit summary……………………………………………………………………………….38
 BACHELOR OF SCIENCE IN NURSING

Unit 4
Unit Title: Curriculum Development and Design...........................................................................39
Introduction: ………………………………………………………………………………...39
First topic: Factors that influence curriculum development.....................................................40
Second topic: Approaches to curriculum development............................................................43
Third topic: The constituent elements of a curriculum.............................................................46
Fourth topic: The process of curriculum development.............................................................47
Unit summary………………………………………………………………………………..50

Unit 5
Unit Title: Teaching/Learning Methods and Learning Aids ………………………………...52
Introduction …………………………………………………………………………….........52
First Topic: Teaching and learning methods………………………........................................54
Second Topic: Audio Visual Aids in Education.......................................................................67
Unit summary………………………………………………………………………………..69

Unit 6
Unit Title: Clinical Teaching………………………………………………………………..70
Introduction ……………………………………………………………………………........70
First Topic: Educational Characteristics of Clinical Teaching.................................................72
Second Topic: Knowledge Bases of Clinical Teaching............................................................72
Third Topic: Skills Taught in the Clinical Teaching ...............................................................73
Fourth Topic: Clinical Teaching Strategies .............................................................................73
Unit Summary...........................................................................................................................83

Unit 7
Unit Title: Measurement and Evaluation of Learning and Teaching..............................................84
Introduction...................................................................................................................................84
First Topic: Approaches to Measurement and Evaluation......................................................84
Second Topic: Principles Measurement and Evaluation.........................................................86
Third Topic: Methods of Measurement and Evaluation.........................................................90
Fourth Topic: Validity and Reliability in Assessment............................................................96
Unit Summary........................................................................................................................100

Unit 8
Unit Title: Micro and Lesson Planning.....................................................................................101
First Topic: Teaching Skills....................................................................................................104
Second Topic: Lesson Planning..............................................................................................105
Unit Summary.........................................................................................................................114
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Unit 9
Unit Title: Managing Nurse Education and Training Programmes........................................115
First Topic: Planning and Organizing Educational Programmes...........................................115
Second Topic: Policy Making in the School...........................................................................116
Third Topic: Organising School activities..............................................................................117
Fourth Topic: Determining Work Procedures........................................................................118
Fifth Topic: Planning..............................................................................................................118
Sixth Topic: Budgeting and Costing for School Activities...................................................119
Unit Summary........................................................................................................................122

Unit 11
Unit Title: Guidance and Counselling in Nursing Education.................................................123
First Topic: Scope of Guidance and Counselling....................................................................124
Second Topic: Types of student guidance and counselling services
in nursing education....................................................................................................................125
Unit Summary..............................................................................................................................126
 BACHELOR OF SCIENCE IN NURSING

About this module

The BACHELOR OF SCIENCE IN NURSINGSCIENCE IN NURSING NRS 4330: Nursing

Education Module has been produced by Error! No text of specified style in document., Institute of
Distance Education (IDE).

The module introduces you to the concepts and principles of nursing education. As you may already
know, one of the roles of a nurse is to teach both in the classroom and clinical area. This module will
equip you with knowledge, skills and attitudes that you require to teach.

In this module, you will learn the different educational concepts which will enable you to effectively
teach. You will study trends and issues affecting nursing education in Zambia, formulating educational
philosophy, teaching methods, curriculum design and concepts related to measurement and evaluation.
The module will also prepare you to conduct teaching practice.

How this module is structured:

The module overview
The module overview gives you a general introduction to the module. Information contained in the
module overview will help you determine:

- What you can expect from the module.

- How much time you will need to invest to complete the module.
The overview also provides guidance on:
- Study skills.
- Where to get help.
- Assignments and assessments.
- Activity icons.
- Units.

The module content

The module is broken down into 11 units. Each unit comprises:
- An introduction to the unit content.
- Unit objectives.
- New terminology.
- Core content of the unit with a variety of learning activities.
- A unit summary.
- Assignments and/or assessments, as applicable.

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Resources
For those interested in learning more on this course, we provide you with a list of additional resources
at the end of this; these may be books, articles or web sites.

Your comments
After completing this module, we would appreciate it if you would take a few moments to give us your
feedback on any aspect of this module. Your feedback might include comments on:
- Content and structure.
- Reading materials and resources.
- Assignments and assessments.
- Duration.
- Support (assigned tutors, technical help, etc.)
Your constructive feedback will help us to improve and enhance this course.

Overview
Welcome to MODULE: NURSING EDUCATIONNURSING EDUCATION

Module Learning Outcomes

Learning objectives are statements that tell you what knowledge and skills you will have
when you have worked successfully through a module.

Upon completion of this module, you will be able to:

1. Analyse current trends affecting nursing education and practice
2. Describe the process of formulating educational objectives
3. Apply learning theories to nursing education
4. Design and develop a curriculum relevant to societal needs
5. Design and program instructional material
6. Select and apply appropriate teaching methods.
7. Develop and select tools for measurement and assessment of learners‘
performance.
8. Practice peer review teaching
9. Manage classroom dynamics and interaction with teachers and students
10. Manage Nurse Education and Training Programmes
11. Manage Infrastructure in Nursing Schools
12. Provide guidance and counselling to staff and students

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Timeframe
Expected duration of this module is 106 hours to work through this study
guide and 7 weeks to do teaching practice in a nursing school.
Formal study time required 4 weeks at the beginning of the semester
How long? Minimum Self-study time recommended is 4 hours per week.

Study skills
As an adult learner, your approach to learning will be different to that
from your school days: you will choose what you want to study, you will
have professional and/or personal motivation for doing so and you will
most likely be fitting your study activities around other professional or
domestic responsibilities.
Essentially you will be taking control of your learning environment. As a
consequence, you will need to consider performance issues related to
time management, goal setting, stress management, etc. Perhaps you will
also need to reacquaint yourself in areas such as essay planning, coping
with examinations and using the internet as a learning resource.
Your most significant considerations will be time and space i.e. the time
you dedicate to your learning and the environment in which you engage
in that learning.
We recommend that you take time now—before starting your self-
study—to familiarize yourself with these issues. There are a number of
excellent resources on the web. A few suggested links are:

 [Link]
The ―How to study‖ web site is dedicated to study skills resources.
You will find links to study preparation (a list of nine essentials for a
good study place), taking notes, strategies for reading text books,
using reference sources, test anxiety.

 [Link]
This is the web site of the Virginia Tech, Division of Student Affairs.
You will find links to time scheduling (including a ―where does time
go?‖ link), a study skill checklist, basic concentration techniques,
control of the study environment, note taking, how to read essays for
analysis, memory skills (―remembering‖).

 [Link]
Another ―How to study‖ web site with useful links to time
management, efficient reading, questioning/listening/observing skills,

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getting the most out of doing (―hands-on‖ learning), memory building,

tips for staying motivated, developing a learning plan.
The above links are our suggestions to start you on your way. At the time
of writing, these web links were active. If you want to look for more go to
[Link] and type ―self-study basics‖, ―self-study tips‖, ―self-
study skills‖ or similar.

Need help?
[Link]
You may contact the Institute of Distance Education at the University of
Zambia from 08 00 hours to 17 00 hours. Telephone number +260 211
Help 290719 Fax: +260 211 290719
ide@[Link]

You could also utilize the services of the phone as well as the email
address. For other details, you may visit the website as stated above.
You are free to utilize the services of the University library which opens
from 0700 hours to 2400 hours every working day. As for weekends and
public holidays, the library opens from 0900 hours to1800 hours. It will
be important for you to carry your student identity card for you to access
the library and let alone borrow books. Your contact person in the library
is the Librarian and the email address is library@[Link] .
For ICT problems, you may contact the Centre of Information
Communication Technology cictdirector@[Link]

Assignments

There will be one assignment given in this module. This will be given
separately from the module.

Assignments

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Assessments
Your work in this module will be assessed in the following four ways:
1. One assignment which be submitted at the end of the
Assessments module (worth 10 per cent of the final mark).
2. Two tests (worth 20 per cent of the final mark).
3. Teaching practice for a period of seven weeks to be
conducted at any nursing college and you will be supervised
(worth 20 per cent of the final mark).
4. A written examination set by the institution in which you
are enrolled for this Degree programme (worth 50 per cent
of the final mark).
Several exercises will be required in the course of your work on each
unit. You will also require to conduct micro teaching or peering teaching
during one of your residential schools before you go for teaching practice.
This will be done to help you prepare for your teaching practice. The
details of this assignment are at the end of the module. Note: It is
important that you discuss the study and assessment requirements with
your tutor before you begin work on the module. If you need any help,
consult the Institute of Distance Learning.

You will sit one final examination at the end of the year. (The dates are as
stated on the sessional dates calendar).

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Getting around this

Margin icons
While working through this Nursing Education Module you will notice the frequent use of margin
icons. These icons serve to ―signpost‖ a particular piece of text, a new task or change in activity; they
have been included to help you to find your way around this Module.
A complete icon set is shown below. We suggest that you familiarize yourself with the icons and their
meaning before starting your study.

Activity Assessment Assignment Case study

Discussion Group activity Help Note it!

Objectives Reading Reflection Study skills

Summary Terminology Time Tip

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Unit 1: Introduction to Nursing Education

Introduction
This unit begins with a discussion of principles and concepts relevant to Nursing Education. The unit
introduces you to current trends and issues that affect nursing education and practice. You will also be
required to analyze the various policies and legislation that relate and provide guidelines in nursing
education in Zambia. The unit will also help you understand the concepts relating to philosophy of
nursing education. As you study this module you will undertake various activities to help you
effectively go through the module and help you prepare for your written assignment.

Aim
The unit aims to equip you with knowledge on current trends and issues affecting nursing education.

Objectives
Upon completion of this unit you will be able to:
1. Outline various issues and trends affecting nursing education.
2. Analyse the policies and guidelines for nursing education in
Zambia
3. Define different concepts related to philosophy of nursing
Objectives education.
4. Explain the importance of philosophy of nursing education.
5. Formulate a philosophy of Nursing and nursing education

Other Resources
To study this module, you will need various documents such as the National training policy and
the Human resources development policy from the Ministry of Health (Refer to module on
Professional Nursing Ethics for these documents). You will also need to refer to any curriculum which
has a philosophy such as Diploma in Nursing or Operating Theatre Nursing curricula.

Time Required
To study this unit, you require 4 hours

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1.1 Issues and Trends Affecting Nursing Education and

Practice

Activity 1.1
For the next 5 minutes before you read further, take your notebook and write down what comes to
mind when you think about nursing education and issues that are affecting it in Zambia today. Ask
yourself these questions; how are nurses trained today? Is it better now than before? What makes it
better or worse? Is there anything that is happening that is affecting the education and practice?

In your reflections you might have thought that nursing education has improved because there
is use of technology which has improved the way information is transmitted to the students.
You might have also thought about the fact that the demand for nurses has increased, hence
increased intakes. Your reflections may be correct.

Nursing care has become more complex as disease patterns change and the client
expectations increase. This calls for nurses to be active participants in health care decisions in
order for them to be effective and efficient in understanding how societal, educational, and
health care changes influence health outcomes.

Nurse educators also must be vigilant in learning about these trends and integrating them into
the curriculum. Some of these trends and related issues include the following; Knowledge
explosion which also includes the globalization of knowledge and diseases, the rapid changes
in technology in patient care and education, specialization, Professionalization, changes in the
demographics, political and economic forces and their consequences, social and cultural
forces such as the increase in domestic abuse and violence of all sorts, complexity of physical
and mental health conditions, ethical issues, and the shortage of nursing faculty and nurses.
Let us now examine some of these trends in detail and how they influence nursing education.

Knowledge and Technological explosion

Knowledge has expanded and this has led to the use of conceptual systems of nursing as guides for
education, practice and research. Nursing models now provide a distinct focus for nursing. They
increase nurses‘ confidence that what they are doing is nursing. Technology which includes the use of
different tools such as computers, video in education has also expanded. Organisation of programmes
is not constrained by class size, presence or absence of teacher. Technology also link institutions to
access research results, store analyse and retrieve data. This has ultimately led to improvement in
health care. Increased knowledge production and advances in technology increase the
accountabilities and responsibilities of nursing professionals. Nurses currently learn to
enhance their use of clinical judgment. This entails that nurses must accept that they need to
update the knowledge related to their work, and also learn the technology required to obtain
or apply that knowledge. In view of this, nurse educators need to be current, competent and
confident in using modern technology not only for acquiring or understanding the new

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knowledge but also to discover and use new technology to deliver education that matches the
unique learning needs of the nursing staff.

Activity 1.2 (5 minutes)

Think about technology in current times and write down points on how you think it has affected
nursing education. Think about the effect of technology on students, on teachers, on health care and
teaching and learning processes. Also think about the positive and negative effects..

Specialization
In response to increased knowledge and technology there is endless studying and pursuit of
the most up to date advances e.g. Palliative care, intensive care. This offers more
opportunities to upgrade levels of knowledge and skills and demand for continuing
education. Nurse educators must keep up with developing different curricula and
programmes for nurses. Programmes being developed range from full-time to distance
learning programmes, eLearning, web based programmes, virtual learning and blended
learning

Professionalization
This is an attempt to improve the educational foundation of the profession and qualification of the
members. In order to improve the professionalism among nurses, there is a demand to produce
autonomous professionals who are capable of evaluating knowledge, thinking critically and
demonstrate creativity in managing care and health services.

Political and Economical forces

Government decisions threaten the accessibility of education. Decisions made by the politicians may
at times compromise quality at the expense of quantity. Poverty
Social and cultural forces
Gender issues. Human rights and other movements.

1.2 Formulating a philosophy of nursing education

There are different basic concepts of education and all these have a basis or foundation on
philosophy of education. A nurse educator should know the underlying educational
philosophy of the school in which he/she teaches and he or she should formulate own
philosophy in agreement or disagreement with the educational philosophy of the school in
which they teach. By definition philosophy is the science of all things through their ultimate

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reasons and causes, as discovered by the unaided light of natural reason (Heidgerken, 1965).
It is a system of beliefs and values that we subscribe to either personally or collectively, or
search for values that give direction for choices in one‘s own life (Mellish, Brink & Paton,
2008) e.g. humanism.
The philosophy of education can be defined as the study of the purposes, processes, nature
and ideals of education. Philosophical knowledge may provide a justification for teaching
methodologies; reveal and challenge assumptions about the nature of teaching; and provide a
language for educational debate.

A philosophy of nursing education encompasses the philosophy of nursing and the philosophy
of education. Philosophy of nursing means ‗statements of beliefs about nursing and
expressions of values in nursing that are used as bases for thinking and acting in nursing
practice‘ (Mellish, Brink & Paton, 2008). Philosophy of nursing forms a foundation on beliefs
about people, environment, health and nursing. On the other hand, in philosophy of education,
the emphasis is placed on the student- objectives and means necessary to educate the student
while in the philosophy of nursing the emphasis is placed on the patient-objectives and means
necessary to give nursing care to the patient. Philosophy of education nursing Education states
assumptions about human beings involved, the purpose of nursing, values and norms of the
profession, assumptions about learning and teaching (Mellish, Brink & Paton, 2008).

Types of educational philosophies

 Theistic realism
 Experimentalism
 Neo realism
 Idealism

Philosophy of Nursing Education

The philosophy of nursing education encompasses a philosophy of nursing and philosophy of
education.
Philosophy of nursing education determines:
 selection of students
 Preparation of faculty
 Development of the curriculum
 Attitudes towards patient and community
 Personal life
 Professional growth of student body and the faculty.
Philosophy of nursing education formulates the nursing curriculum, its nature and the end that it
seeks to achieve. Must be specific about specialised functional roles and responsibilities of the
professional nurse within and to society. Each school of nursing formulates its own philosophy using
different lists of essential philosophical issues depending on the priority of values for that school of
nursing.

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Nature of people
Human beings are unique and holistic, have inherent dignity and are worth of respect and care.
Human beings have rights e.g. the right to be kept fully informed about their condition and the right
to make their own decisions and choices etc.

On nursing
Nursing has as its focus the care of individuals and groups, along with social interactions and social
movements that influence health care. This states assumptions about human beings involved, the
purpose of nursing, values and norms of the profession, assumptions about learning and teaching.
E.g belief that students be actively involved in finding and interpreting information for themselves or
that they should passively accept what they are taught.
Educators should be sole transmitters of knowledge or that they should be facilitators of students‘
learning.
Belief that the educative process takes place through planned and purposeful learning experiences
based on clearly stated objectives, guided by qualified educators who recognize and accept individual
differences in learners

Unit summary
In this unit, you have studied different concepts that relate to nursing
education. You worked through a number of concepts on current trends
that affect nursing education such as specialisation, knowledge explosion
Summary and many others. You also studied nursing philosophy and how to
formulate a philosophy of nursing education.
Now look back at the learning outcomes at the beginning of this unit. See
if indeed you are now able to do all the things listed in the five bullets.
Look through your learning journal again and take this chance to review
all your entries.
Congratulations! This means that you are now ready to advance to Unit 2,
which focuses on Learning theories.

Readings
1. Newble D, and Cannon. (1994). A handbook for Medical Teachers. Kluwer Academic
Publishers. London

2. Mellish, J.M., Brink, H.I.L. and Paton, F. (2008). Teaching and Learning the Practice of Nursing.
4th Edition. Heinemann Higher and Further Education (Pty) Ltd. Johannesburg.

3. Quinn, R M. (2005). The Principles and Practice of Nurse Education. Chapman and Hall, London

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Unit 2: Theories of Learning

Introduction
In the previous unit we introduced nursing education and focused on concepts of trends in nursing
education and philosophy. This unit will introduce you to the common theories of learning and you
will learn how individuals learn. There are several theories of learning in education psychology.
However, the unit will only cover the most common ones that you can apply in nursing education.

Aim
The aim of the unit is to equip you with knowledge on nursing theories and how to apply them in
nursing education.

Objectives
Upon completion of this unit, you will be able to:

Objectives
1. Describe the main concepts/tenets of theories of learning.
2. Select and apply concepts from various theories of learning in
teaching nurses.
3. Analyse how different approaches of teaching affect the learning
process.

Time Required
To complete this unit, you require 6 hours

Reflection
Think about these questions for a few minutes.
 What is learning?
 How do we learn?
 What factors combine to help us learn?
 How can we inspire others to learn?

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A learning theory is an attempt to describe how people and animals learn thereby helping us
understand the inherently complex process of learning. Learning theories view learning from different
perspectives. Learning is a complex process that brings together cognitive, emotional, and
environmental influences and experiences for acquiring, enhancing, or making changes in one's
knowledge, skills, values, and world views.

There are several theories in learning and some of them include:

1. Sensory Stimulation theory
2. Reinforcement theory
3. Cognitive-Gestalt approaches
4. Holistic learning theory
5. Humanistic (facilitation) theory
6. Experiential learning
7. Action learning
8. Adult learning (Andragogy)

2.1 Behaviourist Theories

The theory focuses on objectively observable behaviours and discounts mental activities. It
assumes that human behaviour and learning is explained on the basis of what can actually be
observed. In behaviorism, there is transfer of behaviors representing knowledge and skills to
the learner and does not consider mental processing. Behaviorism is based on the assumption
that learning occurs through interactions with the environment. Two other assumptions of this
theory are that the environment shapes behavior and that taking internal mental states such as
thoughts, feelings, and emotions into consideration is useless in explaining behavior.

The teacher gives instruction is to elicit the desired response from the learner who is
presented with a target stimulus. The learner must know how to execute the proper response
as well as the conditions under which the response is made. Instruction also utilizes
consequences and reinforcement of learned behaviors.

Behaviorism identifies conditioning as a universal learning process. There are two types of
conditioning and these are classical conditioning and operant conditioning. The main
proponents of classical conditioning were Ivan Pavlov and J. B. Watson.

Classical conditioning
This is when a natural reflex responds to stimulus. In Pavlov's classic experiment with dogs,
the neutral signal was the sound of a tone and the naturally occurring reflex was salivating in

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response to food. By associating the neutral stimulus with the environmental stimulus (the
presentation of food), the sound of the tone alone could produce the salivation response.

Unconditioned stimulus
The stimulus can either be unconditioned or conditioned. The unconditioned stimulus is one
that unconditionally, naturally, and automatically triggers a response. For example, when you
smell one of your favorite foods, you may immediately feel very hungry and salivate. In this
example, the smell of the food is the unconditioned stimulus.

Unconditioned response
The unconditioned response is the unlearned response that occurs naturally in response to the
unconditioned stimulus. In the above example, the feeling of hunger in response to the smell
of food is the unconditioned response.

Conditioned Stimulus
On the other hand, the conditioned stimulus is previously neutral stimulus that, after
becoming associated with the unconditioned stimulus, eventually comes to trigger a
conditioned response. In our earlier example, suppose that when you smelled your favorite
food, you also heard the sound of a bell. While the bell is unrelated to the smell of the food, if
the sound of the bell was paired multiple times with the smell, the sound would eventually
trigger the conditioned response. In this case, the sound of the bell is the conditioned
stimulus.

Conditioned Response
The conditioned response is the learned response to the previously neutral stimulus. In our
example, the conditioned response would be feeling hungry when you heard the sound of the
bell.

Operant conditioning
This is when a response to a stimulus is reinforced. The main theorists who worked with this
theory were B.F. Skinner and Thorndike). There are five basic processes in operant
conditioning: positive and negative reinforcement strengthen behavior; punishment, response
cost, and extinction weaken behaviour.

Positive Reinforcement
The term reinforcement indicates a process that strengthens a behavior. First, a positive or
pleasant stimulus is used in the process, and secondly, the reinforcer is added (i.e., "positive"
as in + sign for addition). In positive reinforcement, a positive reinforcer is added after a
response and increases the frequency of the response.

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Negative Reinforcement
The term reinforcement always indicates a process that strengthens a behavior; the word
negative has two cues associated with it. First, a negative or aversive stimulus is used in the
process, and second, the reinforcer is subtracted (i.e., "negative" as in a "-" sign for
subtraction). In negative reinforcement, after the response the negative reinforcer is removed
and this increases the frequency of the response. (Note: There are two types of negative
reinforcement: escape and avoidance. In general, the learner must first learn to escape before
he or she learns to avoid.)

Response Cost
If positive reinforcement strengthens a response by adding a positive stimulus, then response
cost has to weaken a behavior by subtracting a positive stimulus. After the response the
positive reinforcer is removed and that weakens the frequency of the response.

Punishment
If negative reinforcement strengthens a behavior by subtracting a negative stimulus, then
punishment has to weaken a behavior by adding a negative stimulus. After a response a
negative or aversive stimulus is added which weakens the frequency of the response.

Extinction
This is when there is no longer reinforcement of a previously reinforced response (using
either positive or negative reinforcement) resulting in the weakening of the frequency of the
response.

Implications to Nursing Education

Practice should take the form of question (stimulus) - answer (response) frames which expose
the student to the subject in gradual steps. The theory requires that the learner make a response
for every frame and receive immediate feedback. Behaviour that is positively reinforced will
reoccur and as such intermittent reinforcement is particularly effective.

As a teacher, you should try to arrange the difficulty of the questions so the response is always
correct and hence a positive reinforcement. The most critical factor is the environmental
condition, that is, the arrangement of stimuli and consequences within the environment. The
instruction focuses on conditioning the learner's behaviour. Ensure that good performance in
the lesson is paired with secondary reinforcers such as verbal praise and good grades.

Although the role of memory is not specifically addressed, there is discussion on the
acquisition of habits. Practicing habits maintains a learner's readiness to respond, disuse results
in "forgetting" over time.

Reinforcement by way of repetition, instructional cues, drill and practice processes strengthens
the exhibition of desired behaviour. The learner focuses on a clear goal, his behaviour

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automatically respond to the cues of that goal. For learning that requires quick reaction with
sure response, this type of instruction is quite appropriate.

2.2 Cognitive Theories

Learning is a change of knowledge state. In cognitivism, knowledge acquisition is described as
a mental activity that entails internal coding and structuring by the learner. Learner is viewed
as an active participant in the learning process. The emphasis is on the building blocks of
knowledge (e.g. identifying prerequisite relationships of content) and structuring, organizing
and sequencing information to facilitate optimal processing.

The main proponents of this theory are Gagne, Bruner and Ausubel. They proposed that
learning is based on the thought process behind the behaviour. They believed that changes of
behaviour are indicators of what is happening in the mind. When a learner receives new
information, it is compared to existing cognitive structures called ‗schema‘.

There are three stages of information processing, that is, sensory register, short term memory
and long term memory. They assert that meaningful information is easier to remember. A
learning task must have a logical meaning which can be related to the student‘s own cognitive
structure.

A student‘s cognitive structures must contain relevant ideas to which the new material can be
connected. In learning, there is knowledge coding and representation, information storage,
retrieval, incorporation and integration of new knowledge with previous information

Implications to Nursing Education

The general principles, concepts and propositions of a subject in the curriculum are presented
first followed by detail. This is done to transfer knowledge to students in the most efficient and
effective manner. Other methods used to communicate or transfer knowledge in the most
efficient, effective manner are mind-independent or mind mapping.

The focus of instruction is to create learning or change by encouraging the learner to use
appropriate learning strategies. Learning results when information is stored in memory in an
organized, meaningful way. As a teacher you are responsible for assisting learners in
organizing information in an optimal way so that it can be readily assimilated. Your
explanations must be clear. You should also use demonstrations, Illustrative examples,

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corrective feedback, mnemonics, chunking information, repetition and concept mapping to

facilitate learning.

Give plenty of opportunity for assimilation and accommodation in order for students to
proceed from one stage to the next. Remember, the richer the experience, the more elaborate
the cognitive structure development. Materials and activities should be geared for the
appropriate level of cognitive development.

2.3 Constructivist Theories

“You cannot teach a man anything; you can only help him to find it within himself”
Galileo Gallilei

Fundamentally, constructivism says that people construct their own understanding and
knowledge of the world through experiencing things and reflecting on those experiences.

The theory focuses on learners building personal interpretation of the world based on
experiences and interactions. Knowledge is embedded in the context in which it is used
(authentic tasks in meaningful realistic settings). The main theorists were Piaget, Vigotsky and
Dewey. The main concepts in the theory are that learning is an active process of constructing
rather than acquiring knowledge and instruction is a process of supporting knowledge
construction rather than communicating knowledge. As a teacher you do not structure learning
for the task, but rather engage learner in the actual use of the tools in real world situations.
As an active process, the learners discover and construct new ideas/concepts based on their
current/prior knowledge. The issues that guide this process must be personally or societally
relevant. The learner selects information, constructs ideas based on that information and makes
decisions by relying on their own cognitive structure of information. Therefore, instruction
should allow the learner to discover principles for themselves through active dialog.
Instructors should become information facilitators instead of information transmitters.

Instruction must be concerned with the experiences and contexts that make the student willing
and able to learn. It must be structured so that it can be easily grasped by the student (spiral
organization) and should be designed to facilitate extrapolation and/or fill in the gaps (going
beyond the information given).

Experiences are also critical in constructing meaning. By reflecting on our experiences, we

construct our own understanding of the world we live in. The learner will use sensory input
and constructs meaning out of it. The crucial action of constructing meaning is mental.
Learning is not the passive acceptance of knowledge which exists "out there".

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Implications to Nursing Education

Promotes a more open ended learning experience, methods and results of learning not easily
measured, and may differ for each learner. When teaching, you should provide real-world,
case based learning, contextualised environments.

You should create novel and situation-specific understandings by "assembling" knowledge

from diverse sources appropriate to the problem at hand (flexible use of knowledge)

When using constructivism, you should adapt the curriculum to address students‘ suppositions.
The teacher must negotiate goals and objectives with learners and pose problems of emerging
relevance to students. Encourage and help the students to develop own goals and assessments.
Encourage them to control their own learning through reflecting.

You need to emphasize hands-on, real-world experiences and seek and value students‘ points
of view. As you teach, you should create new understandings via coaching, moderating,
suggesting and ensure that testing is integrated with the task and not a separate activity. To
enhance learning, also promote collaboration between instructors, students and others
(community members). This fosters active, challenging, authentic and multidisciplinary
learning. The student will develop life-long learning.

When asking questions pose problems that are or will be relevant to students and structure
learning around essential concepts. Remember that students‘ points of view are windows into
their reasoning.

Some teaching strategies that are used in constructivist theories include collaborative learning,
coaching, scaffolding, and problem-based learning.

2.4 Facilitation Theory (The Humanistic Approach)

The main exponent of the humanistic approach to psychology is Abraham Maslow. The other
person well known for this theory is Carl Rogers. The basic premise of this theory is that
learning will occur by the educator acting as a facilitator, that is by establishing an atmosphere
in which learners feel comfortable to consider new ideas and are not threatened by external
factors (Laird, 1985). Rogers states ten principles of learning:
1. Human beings have a natural potentiality to learn.
2. Significant learning takes place when the subject matter is perceived by the student as
having relevance for his or her own purposes.
3. Learning which involves a change in self-organisation – in the perception of oneself –
is threatening and tends to be resisted.
4. Those elements of learning which is threatening to the self are more easily perceived
and assimilated when external threats are minimal.
5. When threats to the self are low, experience can be perceived in differentiated fashion
and learning can proceed.

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6. Significant learning is acquired through doing.

7. Learning is facilitated when the student participates responsibly in the learning process.
8. Self-initiated learning that involves feelings as well as the intellect is most lasting and
pervasive.
9. Independence, creativity and self-reliance are all facilitated when self-criticism and
self-evaluation are basic and evaluation by others is of secondary importance.
10. The most socially useful learning in the modern world is learning how to learn, a
continuing openness to experience and the willingness to change in response to what
has been learned.

Facilitative teachers are:

 Less protective of their constructs and beliefs than other teachers
 More able to listen to learners, especially to their feelings
 Inclined to pay as much attention to their relationship with learners as to the content of
the course
 Apt to accept feedback, both positive and negative and to use it as constructive insight
into themselves and their behaviour
Learners:
 Are encouraged to take responsibility for their own learning
 Provide much of the input for the learning which occurs through their insights and
experiences
 Are encouraged to consider that the most valuable evaluation is self-evaluation and that
learning needs to focus on factors that contribute to solving significant problems or
achieving significant results.

Implications to Nursing Education

Dembo (1981) suggests that teachers should do the following; set the initial mood or climate
through trust. The teacher as a facilitator should demonstrate acceptance of the student as a
person in his or her own right as a person worthy of their respect. As a teacher, you should
involve students in decision making as a step in helping students to develop a sense of
personal value and worth.

The teacher should clarify the individual and group purposes. In other words, discuss why
learners are at school and in a particular class. As a facilitator, the teacher should collect and
organise as many resources for learning as is possible. You should be flexible in your teaching
role and accept emotional and intellectual responses so as to benefit each individual learner.

When the learning tone has been established, participate in learning along with the students.
Make yourself available to all your learners and be alert to the feelings of your learners so that
you can empathize or put yourself in their place and, therefore, apply those feelings
constructively. Accept and recognize your own limitations – none of us knows it all.

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2.5 Andragogy and Pedagogy

In the early 1970‘s, an educator named Malcolm Knowles proposed that adults learn differently
than do children and used the term ―andragogy‖ to describe his philosophy of ―the art and science
of teaching adults.‖ The term andragogy is used to contrast pedagogy, literally meaning a leader of
children. Knowles‘ approach is based upon the differences he perceives between the teaching of
children and adults.

Different assumptions of pedagogy and andragogy are summarised in the table below.

Assumption Pedagogy Andragogy

Learner‘s need to Students must learn what they are Adults need to know why they
know taught in order to pass their tests. must learn something.
Learner‘s self Dependency: decisions about Self-direction: adults take
concept learning are controlled by the teacher. responsibility for their own
learning.
Role of the learner‘s It is the teacher‘s experience that is Adults have greater and more
experience seen as important. The learner‘s varied experience which serves as
experience is seen as of little use as a a rich resource for learning.
learning resource.
Learner‘s readiness Learner‘s readiness is dependent Adult‘s readiness relates to the
to learn upon what the teacher wants them to things he or she needs to know
learn. and do in real life.
Student‘s orientation Learner equates with the subject- Adults have a life centred
to learning matter content of the curriculum. orientation to learning involving
problem-solving and task-centred
approaches.
Student‘s motivation Student‘s motivation is from external Adult‘s motivation is largely
sources such as teacher approval, internal such as self-esteem,
grades and parental pressures. quality of life and job satisfaction

Source: Quinn, 1995

2.6 Learning

Now that we have discussed the theories of learning, let us take a closer look at learning
itself. People have described learning in several different ways. Learning is a process that
brings together cognitive, emotional, environmental influences and experiences for
acquiring, enhancing, or making changes in one's knowledge, skills, values, and world
views. In learning, there is acquisition of, knowledge, skills, attitudes and a change in the
organization of behaviour giving the individual more effective control over the conditions of
her/his experience.
One of the main themes running throughout the recent changes in education for health
practitioners is the shift from a teacher centered approach to a more learner centered
approach. In this case, learning involves putting the learner‘s needs at the centre of activities

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and this may not always be easy in a busy clinical environment with increasing service
pressures.

Characteristics of Learning
The characteristics of learning will be discussed from a learner centred approach.

Unitary
This means that a learner responds as a whole person in a unified way to the whole learning
situation. The learner will respond intellectually, emotionally, physically, spiritually and all
these aspects occur simultaneously.

Individual and Social

Each individual learns at his or her own pace. This entails that you as a teacher should view
your learners differently. Each learner must also take responsibility for their own learning.
The other aspect emphasises that learning takes place as a response to the social environment
in which the learner is interacting.

Self –active
Each person develops own habits of learning. It is also important to emphasise that the
learner takes an initiative to learn and must be self-directed as they learn. The role of the
teacher is to facilitate the learning process.

Purposive
The learner will only learn when they see relevance of what they are learning. Learning
therefore must be goal oriented. The responses are selected and organised in terms of
relevance to the learner‘s goal.

Creative
Learning is a creative synthesis of all knowledge and the experience of the learner. When the
learner comes to the learning situation, they already know something. When they receive
new knowledge, they will compare it with the existing knowledge and change or modify
what they already know. There is new organization of knowledge and pattern of experience.

Transferable
Whatever is learned in one context or situation is applied or affects another context or
situation. Learning is said to take place only when the individual acquires a type of
knowledge or a skill or changes attitudes and appreciations in response to a real need and
modifies behaviour in accordance with the new learning. For instance, if a learner learns to
budget health resources, they should be able to budget in any other situation.

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Principles of Learning
The principles of learning will be discussed form a constructivist and learner centred point
of view.

Learning is an active process

This means that the learner uses sensory input and constructs meaning out of it. The learner
needs to do something; learning is not the passive acceptance of knowledge which exists
"out there" but learning involves the learner/s engaging with the world.

People learn to learn as they learn

Learning consists both of constructing meaning and constructing systems of meaning. For
example, if we learn the chronology of dates of a series of historical events, we are
simultaneously learning the meaning of a chronology. Each meaning we construct makes us
better able to give meaning to other sensations which can fit a similar pattern.

The crucial action of constructing meaning is mental

Learning happens in the mind. When the learner sees something or experiences some
situation, they construct meaning and make interpretation of that situation. Physical actions,
hands-on experience may be necessary for learning, especially for children, but it is not
sufficient; you need to provide activities which engage the mind as well as the hands.

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Learning involves language: the language we use influences learning.

Researchers have noted that people talk to themselves as they learn. There is a collection of
arguments, presented most forcefully by Vigotsky, that language and learning are
inextricably intertwined. For instance, materials and programs in one‘s own language is an
important factor in facilitating learning.

Learning is a social activity

Our learning is intimately associated with our connection with other human beings, our
teachers, our peers, our family as well as casual acquaintances. Progressive education
recognizes the social aspect of learning and uses conversation, interaction with others, and
the application of knowledge as an integral aspect of learning.

Learning is contextual
We do not learn isolated facts and theories in some abstract ethereal land of the mind
separate from the rest of our lives: we learn in relationship to what else we know, what we
believe, our prejudices and our fears. Learning is active and social and we cannot divorce
our learning from our lives.

One needs knowledge to learn

It is not possible to assimilate new knowledge without having some structure developed
from previous knowledge to build on. The more we know, the more we can learn. Any effort
to teach must be connected to the state of the learner and must provide a path into the subject
for the learner based on that learner's previous knowledge.

It takes time to learn: learning is not instantaneous.

For significant learning to take place, we need to revisit ideas, ponder them try them out,
play with them and use them.

Motivation is a key component in learning and is essential for learning.

Unless we know "the reasons why", we may not be very involved in using the knowledge
that may be instilled in us even by the most severe and direct teaching.

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A Taxonomy Of Significant Learning

Interactive Nature of Significant Learning (Fink, 2003)

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Reflection
Now that you have completed this unit, what aspects of it do you think will help you to perform
better in the classroom?

Unit summary

Summary This unit noted that the purpose of learning theories is to help us predict
and explain the relationship between learning conditions and outcomes.
Four major learning theories were presented. Behaviourist theory focuses
on objectively observable behaviour and the effect of the environment on
learning. Cognitive theory focuses on the work of the brain during the
learning process. Constructivist theories focus on constructing meaning
out of a learning situation while humanist theory states that learning is a
mind and body experience and that human beings have an inherent desire
to learn. The unit concluded by highlighting characteristics and principles
in learning form a learner-centred approach.

Now look back at the learning outcomes at the beginning of this unit. See
if indeed you are now able to do all the things listed in the five bullets.
Look through your learning journal again and take this chance to review
all your entries.

Congratulations! This means that you are now ready to advance to Unit 3,
which focuses on formulating educational objectives.

Assignment

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Unit 3: Formulating Educational Objectives

Introduction
In unit 2, we discussed learning theories and other concepts that relate to learning. We will
now go on and discuss formulating educational objectives. The unit begins with a brief
overview of educational objectives followed by a detailed discussion of the Bloom‘s
taxonomy of educational objectives. It is important that you understand the purpose of
educational objectives because the first step of any educational planning involves deciding
and conveying the objectives.

Aim
The unit aims at equipping you with knowledge in formulating educational objectives.

Objectives
Upon completion of this unit you will be able to:
1. Describe the three broad domains of educational objectives
2. Classify the domains into hierarchical pattern
3. Formulate educational objectives

Objectives

Time Required
To study this unit, you will require 4 hours.

Overview of Educational Objectives

The first step of educational planning involves deciding and conveying the objectives of the
educational programme in a systematic manner. It is also an essential step before choosing
teaching methods and a system of evaluation.

Every educational activity should have a goal. The goal focuses on what the learner will
experience, rather than what the instructor will share or do. Educational objectives are
generally structured around several classification systems known as taxonomies of
educational objectives. The commonly used is the Bloom‘s Taxonomy. In this taxonomy,
objectives are defined by using behavioral terms corresponding to the tasks to be

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accomplished. Objectives indicate what the graduates of a given school will be able to do at
the end of training.

Activity 3.1
Before you go further in your study of this unit, for the next 5 minutes take your notebook and write
down what comes to mind when you think about the difference between aim, objective, and goal.
The three words are sometimes used interchangeably although they are quite different.

3.1 Definitions
Goal
A goal is a statement about the general aims or purposes of education. Goals are broad, long-range
intended outcomes of a program, department, college or university. They are used primarily in
policymaking and general program planning. Goals are also general intentions, intangible, abastract
and generally hard to measure.

Objective
On the other hand, objectives are brief, clear statements that describe the desired learning outcomes
of instruction. They are specific, precise, tangible, concrete and measurable. Attention is focused on
the specific types of performances that students are expected to demonstrate at the end of instruction.

Goals express intended outcomes in general terms written in broad, global language while objectives
express intended results in terms of specific student behaviors. When designing a course, the
intentions of the courses are usually expressed in the form of learning objectives. Objectives are clear
statements of what students should be able to do as a result of a course of study. Aims are usually
statements of what a teacher intends to do. Goals indicate what a course or institution is seeking to
achieve.

In 1956 Benjamin Bloom and colleagues attempted to classify educational activities based on the
objectives of education. Bloom proposed that educational objectives fall into three broad categories
of domains: Cognitive or knowledge, Psychomotor or skill, Affective or attitude. This is also known
as taxonomy of educational objectives. The domains are most commonly used extensively in
assessment and evaluation.

Each of the three broad domains of education is further sub-classified into levels (hierarchical
pattern). Higher levels are more complex and intellectually demanding than lower levels. A goal of
Bloom's Taxonomy is to motivate educators to focus on all three domains, creating a more holistic
form of education. Objectives at the lower levels are mastered first before higher level objectives are
accomplished. Learners sequentially progress from one level to the next. Let us look at these domains
in more detail and see how they can be applied in education.

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3.2 Cognitive Domain

This is also known as knowledge/intellect domain. It is the most commonly used of the domains by
educators and students. It refers to knowledge structures and it is sub-divided into six levels. It is
frequently used to describe the increasing complexity of cognitive skills as students move from
beginner to more advanced knowledge of content. It is the core learning domain because the other
domains require at least some cognitive component. The levels of the cognitive domain as originally
proposed by Bloom are discusses below.

Knowledge
This is the ability to recall or remember previously learned materials without much understanding of
the meaning. The representative verbs that can be used when writing objectives are list, write,
identify. For example, define the term empathy.

Comprehension
This follows acquisition of knowledge by learners. It is exemplified by the ability to understand the
meaning of an idea or a concept. Verbs that can be used when formulating objectives are describe,
compare, contrast, rephrase, put in your own words, and explain the main idea. For example, explain
the meaning of empathy as it relates to counselling.

Application
In application, the learner shows ability to use or apply previously learned information to reach an
answer. It involves application of principles in new situations and demonstration of correct use of
procedures. Example of verbs that can be used are apply, demonstrate, classify, use, choose, employ,
determine and operate. For example, when provided with the given formula to calculate body surface
area and a drug handbook, nurses will be able to determine the correct penicillin dosage for the
patient.

Analysis
Analysis is the ability to separate a complex concept into component parts and establish relationship
between parts. It relates to the ability to determine relevance and usefulness of information and
correlate between the information. It involves asking higher order questions that require students to
think critically and in depth. Unless students can be brought to the higher levels of analysis,
synthesis, and evaluation, it is unlikely that transfer will take place. If teachers don't ask higher level
questions, it is unlikely that most students will transfer school work to real life. Sample verbs include
identify motives/causes, draw conclusions, determine evidence, support, analyze, categorise,
diagnose, outline. For example, analyse the method that the counsellor used in the case study that
caused the article to be biased.

Synthesis

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Synthesis involves construction of new ideas or hypotheses and establishment of new relationship
between theories. In synthesis, higher order questions that ask the student to perform original and
creative thinking are asked. For instance the ability to write a well-organised theme, write a research
proposal or plan an experiment. Sample verbs include predict, produce, write, design, develop,
synthesize, construct, solve, propose. For example, students will be able to propose a hypothesis that
will explain the possible mechanism of adverse neurological outcomes that are associated with
prolonged dexamethasone use. How would you have improve upon the strategy employed in this
counselling case study?

Evaluation
This is the highest level of the cognitive domain. It is demonstrated by the ability to judge the worth
of data against stated criteria. For example, ability to judge the value of a research paper, comparing
between treatment modalities and selecting appropriate treatment guidelines for a patient. It requires
the student to judge the merit of an idea or a solution to a problem. The verbs that can be used
include judge, compare, validate. For example validate the best counselling technique to use in this
case study.

Revised Cognitive Domain

Bloom's six major categories were changed from noun to verb forms in the new version
which was developed in the 1990‘s and released in 2001. The knowledge level was renamed
as remembering. Comprehension was retitled understanding, and synthesis was renamed as
creating. In addition, the top two levels of Bloom‘s changed position in the revised version.

Bloom’s – Old Version (1956) Bloom’s ‐ New Version (1990’s)

Facilitating learning in the Cognitive Domain

Activity 3.2
Think of the cognitive domain and write down ways in which you can facilitate learning in the

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cognitive domain.

As you move up the cognitive domain to synthesis and evaluation, collaborative assignments
requiring students to engage in problem-based or project-based activities serve as important ways to
determine if students have reached that level of learning. Higher cognitive skills provide
opportunities for student to develop interpersonal domain learning. To the extent that we desire
interpersonal learning outcomes, we should consider how to facilitate face-to-face interactions.
Include critical thinking exercises.

Learning Tip

Blooms Taxonomy in the cognitive domain can be arranged in a hierarchy, from less to
more complex as follows: Knowledge, Comprehension, Application, Analysis, Synthesis
and Evaluation. When selecting objectives teachers must also build the level of the content
to be taught and activities to be learnt from simple to the complex.

3.3 Affective Domain

This domain is concerned with value issues, perception of value issues, interests, attitudes, opinions,
appreciations, and emotional sets. Attitudes have emotional, cognitive and behavioural components.
It includes empathy towards patients and respect for individuals. However, the domain has received
less attention although it is significant in nursing. It deals with feelings and attitudes which constitute
the caring functions.

Attitudes are internal states that modify choices of personal actions towards objects, persons or
events (Gagne, 1977). They are evaluation of ideas, events, objects or people (Sdorow and
Rickabaugh, 2002). The domain consists of five levels as discussed below.

Receiving/Attending/Awareness
At this level, the learner is sensitive to the existence of something and progresses from awareness to
controlled or selected attention. It also includes sensitivity to the existence of a certain phenomenon
or stimulus, and [Link] student passively attends to particular phenomena or stimuli for
example, classroom activity. The student is also willing to receive or pay [Link] teacher's
concern is that the student's attention is focused. Sample objectives include: listens attentively, shows
sensitivity to social problems. Behavioral terms are: asks, chooses, identifies, locates, points to, sits
erect.

Responding/react

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This is concerned with active response by the learner, although commitment is not yet demonstrated.
The learner is sufficiently involved in a subject, phenomenon or activity. The range is from reacting
to a suggestion through to experiencing a feeling of satisfaction in responding. Examples of
objectives are: completes homework, obeys rules, participates in class discussion, shows interest in
subject, enjoys helping others, etc. the behavioral terms are; answers, assists, complies, discusses,
helps, performs, practices, presents, reads, reports, writes etc.

Valuing/understand and act

This describes the worth or value a person attaches to a particular object, phenomenon, or
behaviour. It ranges from simple acceptance to the more complex state of commitment. Valuing is
based on the internalization of a set of specified values, while clues to these values are expressed in
the learner's overt behaviour and are often identifiable. Objectives indicate acceptance and
internalization of the values or attitudes in question. At this level, behaviour is consistent and stable
in everyday life. It also involves not only acceptance of a value but also preference for it. Ranges
from acceptance to commitment (e.g., assumes responsibility for the functioning of a group). Sample
objectives could be; shows concern for others' welfare, demonstrates a problem-solving approach
and behavioural terms could be phrased as invites, differentiates, explains, initiates, justifies,
proposes, shares, etc.

Organization
This is the ability to organize values and to arrange them in an appropriate order. The learner
constructs a value system which guides behaviour. They bringing together different values, resolving
conflicts among them, and start to build an internally consistent value system by comparing, relating
and synthesizing values and developing a philosophy of life. The sample objectives could be
understands the role of systematic planning in solving problems, accepts responsibility for own
behavior, etc. the behavioural terms include arranges, alters, combines, compares, generalizes,
integrates, modifies, organizes, synthesizes, etc.

Characterization by value or value concept

This level indicates internalisation of the value. At this level, the person has held a value system that
has controlled his behavior for a sufficiently long time that a characteristic "life style" has been
developed. The value system becomes a philosophy of life. In nursing education, you acquire new
attitudes and values or modify the existing ones. The behaviour must be consistent and predictable.
Objectives under this level are concerned with personal, social, and emotional adjustment for
example displays self reliance in working independently, cooperates in group activities, maintains
good health habits, etc. the behavioural terms are acts, discriminates, displays, influences, listens,
modifies, performs, practices, proposes, qualifies, questions, revises, serves, solves, verifies.

Facilitating learning in the Affective Domain

Activity 3.2
Think of the affective domain and write down ways in which you can facilitate learning in the
domain. .

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Students should be willing to ―show up‖ for class, participate in class, and become involved with the
content. Encourage students to expend effort in their courses and sustain the effort throughout the
duration of the course. Encourage them to take the next higher course or another course in the
curriculum because they value what they have learned. Class meetings or an initial class meeting to
support an online course might be used for affective [Link] students giving tips on
how to be successful Professionals who are using the knowledge from the course in their lives can
talk to the students. The instructor informing the students of the value of the course. Additionally,
chunking information into small steps and designing opportunities for the students to be successful
facilitate affective learning for students. Encouraging students to set goals for themselves that are
reasonable can also enhance affective learning. Include more affective learning outcomes.

3.4 Psychomotor Domain

The psychomotor domain includes physical movement, coordination, and use of the motor-skill
areas. Development of these skills requires practice and is measured in terms of speed, precision,
distance, procedures, or techniques in execution. This domain is characterized by progressive
levels of behaviors from imitation to mastery of a physical skill.

Imitation/copy
This is the earliest stage in learning a complex skill, overtly, after the individual has
indicated a readiness to take a particular type of action. Imitation includes repeating an act
that has been demonstrated or explained, and it includes trial and error until an appropriate
response is achieved. The student watches the teacher or trainer and repeat action, process or
activity. The sample objectives are adhere, begin, bend, assemble, attempt, carry out, follow,
mimic etc.

Manipulation
The learner continues to practice a particular skill or sequence until it becomes habitual and
the action can be performed with some confidence and proficiency. The response is more
complex than at the previous level, but the learner still isn't "sure of him/herself." The
learner is able to perform certain actions by following instructions and practicing. The
sample objectives are similar to those used under the imitation level.

Precision
In this level, the skill has been attained. Proficiency is indicated by a quick, smooth, accurate
performance, requiring a minimum of energy. The overt response is complex and performed
without hesitation. Few errors are apparent and the student performs a task or activity with
expertise and to high quality without assistance or instruction. They are also able to
demonstrate an activity to other learners. Sample objectives include; achieve, accomplish,
advance, automatize, calibrate, complete, control, demonstrate, differentiate (by touch),
exceed, excel, master, perfect, reach, refine, show, succeed, surpass, transcend etc.

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Articulation
This involves an even higher level of precision. The skills are so well developed that the
individual can modify movement patterns to fit special requirements or to meet a problem
situation. There is coordinating a series of actions, achieving harmony and internal
consistency. The learner is able to relate and combine associated activities to develop
methods to meet varying, novel requirements. Sample objectives are adapt, alter, change,
construct, combine, coordinate, develop, excel, express (facially), formulate, integrate,
master, modify, rearrange, reorganize, revise, solve, surpass, transcend.
Naturalization
At this level response is automatic. The individual begins to experiment, creating new motor
acts or ways of manipulating materials out of understandings, abilities, and skills developed.
One acts "without thinking." Having high level performance become natural, without
needing to think much about it. Sample objectives are arrange, combine, compose, construct,
create, design, invent, manage, originate, project-manage, refine, specify, transcend.

Facilitating learning in the Psychomotor Domain

Activity 3.3
Think of the psychomotor domain and write down ways in which you can facilitate learning in the
domain.

The psychomotor domain is best taught in a face-to-face situation. Since there is a cognitive
component underlying motor skills, they can be effectively viewed in videos, demonstrations, online
text descriptions, or with pictures of each step in the sequence. Simulations can be used to help
people learn the steps or practice variations of a motor sequence. More important, the student should
perform the skill with an instructor judging if the skill was performed to a set standard. Sometimes,
simulations are used for learning without ―hands on‖ opportunities, because the psychomotor activity
is dangerous or equipment is not readily available. Students who are new to a content area will
generally benefit more from ―hands-on‖ learning than from mediated learning within the
psychomotor domain. As students become more expert, videos and pictures can be used to teach the
skill. Clinical/Lab teaching often involves seeking out opportunities for learners to practice skills
ranging from simple procedures to much more complex skills such as carrying out an operation.

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Unit summary

Summary In summary, the unit has discusses formulation of objectives in the

cognitive, psychomotor and affective domains.

The cognitive domain focuses on acquisition of knowledge. It

includes what a learner recalls or understands.

Affective domain focuses on acquisition of particular attitudes,

values or feelings towards an object or phenomena. The learners
demonstrate interest and motivation in learning certain concepts.
The domain is very critical in nursing education because they
always interact with clients in their practice.

Psychomotor domain involves movement, coordination, and use of the

motor-skill areas. The learner learns how to manipulate an
instruments and perform clinical procedures.

Now look back at the learning outcomes at the beginning of this unit. See
if indeed you are now able to do all the things listed in the five bullets.
Look through your learning journal again and take this chance to review
all your entries.

Congratulations! This means that you are now ready to advance to Unit 4,
which focuses on curriculum design and development.

Assignment

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Unit 4: Curriculum Development and Design

Introduction
In unit 3, we discussed formulating educational objectives. It was emphasised that
educational objectives were very important in any educational activity. In this unit, we will
discuss curriculum design and development. The unit begins with a brief overview of
curriculum design and development, followed by factors influencing curriculum design,
elements of a curriculum, approaches to curriculum design, and finally curriculum design
process.

Aim
The unit aims at equipping you with knowledge in curriculum design and development.

At the end of the unit, you should be able to:

1. Outline the factors that influence curriculum development
2. Describe the basic steps in curriculum planning and implementation
3. Describe the different approaches to curriculum development
4. Analyse the barriers to curriculum innovations and ways to overcome them.

Time Required
To study this unit, you require 6 hours

A curriculum is used to describe the plan or design upon which the nature or mode of
education is based. It prepares the nurse with knowledge, skills and attitudes that would
enable her/him respond to all the needs and trends in health care. Curriculum is underpinned
by a set of values and beliefs about what students should know and how they come to know
it. The values that underlie the curriculum should enhance health service provision. It must
be responsive to changing values and expectations in education to remain useful. In the
curriculum the terminal objectives are stated, the sequence of prerequisites capabilities is

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described. The initial capabilities/competencies assured to be possessed by the students are

identified.

The word curriculum is derived from the Latin word currere meaning ‗to run‘. One of the functions
of a curriculum is to provide a template or design which enables learning to take place. In a
curriculum, learning that is expected to take place during a course or programme of study in terms of
knowledge, skills and attitudes is outlined. The curriculum also specifies the main teaching, learning
and assessment methods and provides an indication of which learning resources will be required to
support the effective delivery of the course. A curriculum is more than a syllabus. A syllabus
describes the content of a programme and can be seen as one part of a curriculum. Most curricula are
not developed from scratch and all operate within organisational and societal constraints.

4.1 Definition
What is a curriculum?

Several definitions of a curriculum exist. However, we will only consider two definitions.
According to Gagne, curriculum is defined as ―a sequence of content units arranged in such
a way that the learning of each unit may be accompanied as a single act provided the
capabilities described by specified prior units in the sequence have already been mastered by
the learner‖ (Gagne, 1967).

Curriculum is the totality of learning experiences provided to students so that they can attain general
skills and knowledge at a variety of learning sites (Marsh and Willis, 2003). A curriculum is all the
experiences provided by the institution or agency which are designed to foster student
learning.

4.2 Factors Influence Curriculum Development

There are several factors that influence curriculum design and development. Some of these
are discussed below.

Philosophy of Nursing Education

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This is a vital factor in the curriculum and forms the basis for the final selection of the
reviewed aims and objectives of the curriculum. The philosophy of nursing education
provides directive knowledge and guiding principles which unify and serve as criteria for
evaluation of aims and objectives.

Educational Psychology

Both child and adult learning theories within the psychology field influence curriculum
development. Understanding the psychology behind learning theories implemented in
curriculum development maximizes learning with content, delivery, interactive activities and
experiences initiated at the most opportune teaching moment. Learning theories enhances
knowledge of individual differences in the learners, measurement and evaluation, and in
facilitating learning. Theories provide data from which; principles of learning are developed
and they are basis for development of principles and methods of teaching. Learning theories
also serve as background for principles of teaching and curriculum development.

Society

This includes the type of society where the students will serve. The health and social needs
of patients, families and communities must be taken into consideration. Social changes such
as urbanization and cultural adjustments are important factors that influence curriculum
development. Technologic changes leading to Easy transportation increasing mobility and
ultimately new needs created by industrialization and urbanization.

Social diversity including religion, culture and social groupings affects curriculum
development as well because these characteristics influence the types of topics and methods
for teaching information. Developing relevant curriculum takes into account society's
expectations, accommodating group traditions and promoting equality.

Student

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Nature of the student is an important factor in curriculum design and development. This
involves issues of whether the students are young or mature. Individual needs and interests
must be taken into consideration as you develop curriculum.

Life Activities

Professional, personal, spiritual, family activities of nurses individually and in groups

influence curriculum development. Curriculum should provide for development in all these
activities.

Knowledge Expansion

Knowledge is central to all curriculum development. Knowledge includes aspects of

foundational, sciences, humanities, and nursing related fields. Curriculum must be designed
to prepare students to test, to use, and to understand in the future concepts and ideas which
are non-existent today.

Political factors

How politics influences curriculum design and development starts with funding. Both
private and public educational institutions rely on funding for hiring personnel, building and
maintaining facilities and equipment. All aspects of curriculum depend on local, state and
national political standards. From defining goals, interpreting curricular materials to
approving examination systems, politics affects curriculum development. Curriculum in
schools and colleges needs to be approved and meet the standards of the state. Changes in
government or political strategies and policies affect the planning of appropriate curriculum.

Economic Factors

Nations financing education expect an economic return from educated students contributing
to the country's economy with global competition abilities in technical fields. Curriculum
content influences learner goals, standards for academic achievement with an underlying

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influence of the nation's economy. For in house training in a corporation, curriculum it

focuses on educating employees for promotions that bring better returns in profits.

Technology

Due to the huge impact that technology has over society, it is also a factor that can affect the
curriculum development as a lot more lessons are being taught using computer programs. A
lot of learning centres use computer technology to help students interact and learn new
skills. This is one of the major, and most changing, factors that can affect curriculum in
educational institutes. Learning centres and classrooms increasingly provide computers as
requisite interaction for studies among students. Technological multimedia use influences
educational goals and learning experiences among students.

4.3 Approaches to Curriculum Development

Product (Objectives) Model
The objectives model takes as its major premise the idea that all learning should be defined in terms
of what students should be able to do after studying the programme, in terms of learning outcomes or
learning objectives. Some key theorists who worked with this model are Tyler (1949), Bloom
(1965). When designing a curriculum using the model four fundamental questions must be
asked:

1. What are aims and objectives of curriculum?

2. Which learning experiences meet these aims and objectives?

3. How can the extent to which these aims and objectives have been met be evaluated?

4. How can these learning experiences be organised?

(Adapted from Tyler 1949)

Curriculum design according to this model follows four steps:

 Reach agreement on broad aims and specific objectives for the course

 Construct the course to achieve these objectives

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 Define the curriculum in practice by testing capacity to achieve objectives

 Communicate the curriculum to teachers

Care must be taken not to focus on the objectives to a trivial level or narrow specification as
this limits the teacher and valuable learning experiences may be lost. Using an objectives
model enables the construction of assessments which can be designed against the learning
objectives.

Advantages of Product Model

 Avoidance of vague general statements of intent

 Makes assessment more precise

 Helps to select and structure content

 Makes teachers aware of different types and levels of learning involved in particular
subjects

 Guidance for teachers and learners about skills to be mastered

Criticisms of Product Model

 At lower levels, behavioural objectives may be trite and unnecessary

 Difficult to write satisfactory behavioural objectives for higher levels of learning

 Specific behaviours not appropriate for affective domain

 Discourages creativity for learner and teacher

 Enshrines psychology and philosophy of behaviourism

 Curriculum too subject and exam bound

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The objectives (outcomes) model

Curriculum ideas

Evaluation Objectives/outcomes

Content, methods, resources

Process Model

The process model assumes that content and learning activities have an intrinsic value and
they are not just a means of achieving learning objectives and that translating behavioural
objectives is trivializing. The model focuses on teacher activities, teacher‘s role and student
and learner activities which is the most important feature. The model also takes into
consideration the conditions in which learning takes place. The main theorist who proposes
the model is Stenhouse (1975). He emphasises on means rather than ends and that the
learner should have part in deciding nature of learning activities.

 Stenhouse (1975) has argued that there are four fundamental processes of education:
Training (skills acquisition)

 Instruction (information acquisition)

 Initiation (socialization and familiarization with social norms and values)

 Induction (thinking and problem solving)

He claimed that behavioural objectives were only important in the first two processes and
that in initiation and induction it would not be possible to use objectives. From this it was
suggested that behavioural objectives were inappropriate for problem based learning (PBL),
professional development or clinical problem solving.

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Approaches to course design under the process model include the ―intellectual approach,
which examines the subject matter in terms of assumptions held in the discipline with regard
to a particular body of information, knowledge and skills.

Advantages of Process Model

 Emphasis on active roles of teachers and learners

 Emphasis on learning skills

 Emphasis on certain activities as important in themselves and for ―life‖

Disadvantages of Process Model

 Neglect of considerations of appropriate content

 Difficulty in applying approach in some areas

(Process and Product model from Neary, M. (2002) Chapter 3)

The Process model

Curriculum ideas

Evaluation Content, methods, resources

Outcomes

4.4 Constituent Elements of a Curriculum

Philosophy

Aims/objectives/competencies

Content

Teaching and learning strategies

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Assessment processes

Evaluation processes

4.5 Curriculum Development Process

When designing a curriculum, there are critical issues that must be addressed.

 What is the purpose of the curriculum?

 What are the objectives of the curriculum?

 How are the learning experiences to be selected and organized?

 What are the objectives of the course?

 What resources are to be employed, and how are time and space to be used?

 What is the design of the learning activities?

 How is the curriculum to be evaluated?

Identification of the faculty/institution’s mission and the needs of its stakeholder

Formulate or update a mission statement of the institution. The mission statement is largely
determined by societal and national health care needs and priorities and aspirations.

Needs Assessment of the Learners

A comprehensive needs assessment of the learners including learners‘ strengths and

weaknesses must be conducted. Needs assessment is very critical before a curriculum is
designed to develop more appropriate instructional methods and assessment instruments.
Needs assessment data should include; entry level of competence, prior educational
experience, exposure and success with self-directed and group study, ability to meet the
requirements of the programme, individual goals and priorities, personal background
including reasons for enrolling, attitudes towards the discipline, assumptions and
expectations from the programme.

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Establishment of the curriculum’s goals and objectives

Goals and objectives determine the instructional philosophy and guide the selection of the
most effective learning methods. When objectives are written clearly they communicate the
focus of the curriculum to all stakeholders. Ensure that the ultimate educational experiences
of learners are in line with the faculty‘s mission statement. Curricula goals should be set
according to the three domains of education (Knowledge, Attitudes and Skills). The goals
should also take into account newer trends and evidence-based practices in nursing
education. The objectives must target reduction of factual information and promote active
learning. Also consider vertical and horizontal integration and early clinical exposure. There
should also be a balance between hospital and community based nursing.

Selection of Educational Strategies

Selection of educational strategies should be based on three cardinal principles:

 Educational strategy or instructional methods must be congruent with learning

objectives e.g. a learning objective on skills must have demonstration as a strategy

 You must use multiple strategies rather than a single method in order to meet the
demands of specific learning situations

 Take into consideration the diversity and individuality of the students including their
learning styles

 Verify the curriculum‘s feasibility in terms of material and human resources.

Assessment of Students
Student assessment is one of the measures of the intended behaviour change that the
curriculum is entrusted to achieve. Assessment instruments need to be carefully pre-selected,
and planned so that they meet the requisite reliability and validity for the purpose. Student
assessment must be planned at the inception alongside with setting of the learning objectives
and never left to be decided at the end.

Evaluation and Monitoring of the Curriculum

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Evaluation data collected serve as criteria for adjusting the curriculum according to the goals
of the program or the mission of the faculty. The curriculum must be evaluated, corrected,
monitored through repeated levels of innovation and adjustment. Ongoing feedback must be
collected from teachers, tutors and students.

Curriculum evaluation has three major aspects to it:

 The process of describing and judging an educational programme or subject

 The process of comparing a student‘s performance with behaviourally stated objectives
 The process of defining, obtaining and using relevant information for decision-making
purposes (Gatawa, 1990: 50)

The whole process of evaluating a curriculum must encompass all the three activities. That
means data is collected for passing judgment, to identify deficiencies in programmes and to
analyse programmes in order to determine alternatives or find appropriate interventions.
Curriculum is also evaluated to inform decision-makers on the state of affairs of certain
curriculum programmes or syllabuses, and enable teachers to evaluate themselves.

When evaluating curriculum, several aspects are checked as earlier alluded to. These include
curriculum objectives because they form a foundation on which the curriculum programme
or project is based.

Content must also be evaluated to establish whether it is relevant to the needs and aspirations
of the society. When evaluating curriculum content, the focus should be on the effect it has
on learners. It is also important to determine whether the methodology is consistent with the
curriculum objectives (Gatawa, 1990: 56) and is appropriate for the content.

4.6 Curriculum Implementation

Curriculum implementation involves putting into practice the officially prescribed courses
of study, syllabuses and subjects taking into consideration all the learning activities and
experiences of students. This process involves helping the learner acquire knowledge or

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experience. It is important to note that curriculum. The learner is the most important factor
in the curriculum implementation process.

Implementation does not just involve the teacher delivering the courses, but the learner
acquiring the planned or intended experiences, knowledge, skills, ideas and attitudes that are
aimed at enabling the same learner to function effectively in a society (University of
Zimbabwe, 1995: 8).

The teacher as an important element in curriculum development must translate and interpret
the curriculum and deliver relevant information to the students.

Strategies for Implementation of Curriculum Innovations

For you to implement an innovative curriculum, you need to create broad based ownership
through multidisciplinary team work. The most important stakeholders who are consumer
(students) must be involved in the process. There should be active presence of faculty
members with background in nursing or health professional‘s education or experience in
curriculum planning. A strong leadership with a clear vision provided by the Dean or
Principal tutor is important to advocate the necessity for changes in the curriculum.

Unit Summary

Summary
 In this unit, you have studied Curriculum is a dynamic process
that needs a systematic and stepwise implementation
 Curriculum should have a built-in feedback system with
ample room for ongoing modification and adjustment
 Every curricular reform faces a predictable pattern of
resistance
 A broad based consensus among the faculty members is
crucial for successful implementation
 Support from the Dean/Principal and the students has very
valuable impact on the reform process

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 Congratulations for completing unit 4 successfully! This

means that you are now ready to advance to unit 5 which focuses
on teaching approaches.

Readings
Pollard, A. & Triggs, P. (1997) Reflective Teaching in Secondary Education. London:
Continuum
Young, M. & Leney, T. (1997) From A-levels to an Advanced Level Curriculum of the
Future in Hodgson, A. & Spours, K. (eds) (1997) Dearing and Beyond. London: Kogan
Marsh, C.J. (1997) Perspectives: Key concepts for understanding curriculum 1. London:
Falmer Press
Bates I, Bloomer M, Hodkinson P & Yeomans D (1998) ―Progressivism and the GNVQ:
context ideology and practice‖ Journal of Education and Work, 11, 22, 109-25)
Neary, M. (2002) Curriculum Studies in Post-Compulsory and Adult Education.
Cheltenham: Nelson-Thornes. Chapter 3.
Gagné, R. M., Briggs, L. J., & Wager, W. W. (1992). Principles of Instructional Design (4th ed.).
Fort Worth, TX: Harcourt Brace Jovanovich College Publishers.

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Unit 5: Teaching and Learning Methods

I hear and I forget

I see and I remember

I do and I understand

Confucius, 551-479 BC

Introduction
In unit 5, we will discuss various principles and concepts that relate to teaching and learning
and how we can use these methods to facilitate the acquisition of knowledge, skills and
attitudes. The unit begins with a brief overview of teaching and learning methods or
approaches, followed by a discussion on the commonly used approaches in nursing
education and how to select these approaches.

Aim
The unit aims at equipping you with knowledge and skills in selection and use of teaching and
learning approaches to facilitate learning of knowledge, skills and attitudes.

Objectives

At the end of the unit, you should be able to:

1. Explain the different categories of teaching and learning methods
2. Describe the various teaching and learning methods used to facilitate
learning
3. Select appropriate teaching methods to facilitate learning.

Time Required
To study this unit, you require 4 hours

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Activity 5.1
For the next 5 minutes take your notebook and write down the different teaching
and learning methods that you know. Think about those methods that are used both
in the classroom and the clinical setting.

5.1 Definitions
Teaching involves much more than giving out information to students. Teaching involves
classroom management, short and long term planning, knowledge of content, knowledge of
learning styles, use of materials, and an understanding of varied instructional skills and
strategies. These strategies must be relevant and appropriate to transfer information in an
efficient and effective manner.

When discussing teaching methods, you will come across different terminologies that relate to
this concept. Teaching approaches deal with general philosophies of teaching while methods
deal with more practical issues related to teaching. On the other hand teaching strategies deal
with specific actions that a teacher does. However, these terms sometimes overlap and are used
interchangeably.

There are several teaching and learning methods that are available from where you can choose.
A teaching strategy is defined as ―a combination of student activities supported by the use of
appropriate resources to provide a particular learning experience (Rees &Walker, 2002).

Approaches to Teaching and Learning

According to Amin and Eng (2003), teaching and learning methods can be divided into three,
that is, a) expository, b) exploratory, and c) simulation.

Expository
The expository method which comes from the term ‗exposition‘ meaning to showcase is the
unidirectional delivery or presentation of the information to the learner. This involves passive
transfer of information. Examples of this type of method are lecture and reading a book.

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Exploratory
This method prompts the learner to explore and discover by way of interactions. These methods
allow and encourage two way exchange of information. Examples include discussion, question
and answer and brainstorming, case-based and problem based learning.

Simulation
This category allows for practice of learned skills in safe situations that closely resemble real
life. Simulation allows for careful and gradual transfer of learned skills into actual practice.
Role play and use of standardised patients are examples of simulation in medical conditions.

5.2 How to Select an Appropriate Teaching and Learning Method

When selecting teaching and learning methods, you should bear in mind that the benefit
of students is very important in order to facilitate learning. All modern learning theories
stress that learners must have a degree of ownership of the learning process. It is
therefore important that selection of a teaching method be done with the greatest care.
There are several factors that need to be taken into consideration as you select a method
to deliver a particular content.

Aspect Related to Choice Points to Note

Objectives to be achieved Both the domain and the level in the domain need to
be considered

The size of the group Different methods are more appropriate to different
sizes of the class. For example, it may be impractical
to use small group discussion when teaching a class of
seven hundred students.

Content to be taught Certain teaching methods will best be suited for

certain content. For instance, if you are teaching a
skill, you might need to do a demonstration.

The needs and characteristics of Students‘ needs must be considered. This might need
students negotiation. This also includes individual differences

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in your learners.

The ability of the students Ability and ‗intelligence‘ need to be considered

The motivation of the students Appropriate strategies can motivate an individual to

learn

Availability of teaching and learning resources and

Availability of teaching
the ability and willingness of the teacher to improvise
resources if conventional teaching aids are not available

There are several teaching and learning methods that are used in nursing education. The
common ones include:
• Lecture
• Discussion
• Case study
• Demonstration
• Team teaching
• Seminar
• Field trip
• Role play
• Tutorial
• Laboratory workshop

Let us now discuss some of these in detail.

5.3 Lecture
The lecture is one of the most common forms of instruction in nursing education. A lecture is
simply defined as ‗Words spoken by the teacher‘. It is typically expository and passive.
Lectures are useful for conveying information, explaining procedures, clarifying relationships
among general points and transmitting information of factual nature but less effective for the
promotion of thinking skills and the changing attitudes. However, lectures may be modified to
include discussion, demonstration and application.

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Activity
Think about the lecture method, take your note book and write down any five
advantages and five disadvantages of using the lecture method in teaching nursing
students.

Guidelines on delivering Effective Lectures

A basic lecture has got three sections. These are a) introduction, b) body, and c)
conclusion.

Introduction

This is given in the first five to ten minutes of the lesson. Introduction must be much
more than outlining the contents of the topic. It must cover the purpose, organisation
and ground rules of the lecture. To organise your introduction, you can use the
following questions:

 What are the most important features of the topic?

 What is the most important information that I want my students to know?

 What are the key concepts that I would like to share with the students?

 What are the questions that I would like to ask during this lecture?

You need to prepare an introductory note to highlight the important points you need to
consider. For example if you are preparing a lecture on diabetic retinopathy as a
complication of diabetes mellitus, you may want to emphasise the key teaching points
by opening your lecture with this statement: ―Today we will discuss diabetic
retinopathy, a complication of diabetes mellitus. Prevention of this serious complication
requires prompt identification of the clinical features and management of diabetes
mellitus. So in this lecture we will discuss the clinical features of diabetic retinopathy
and the pathophysiological basis of management of this complication‖. This type of
introduction will help your students to concentrate on the important points of the
lecture.

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The Body

This is the major component of the lecture. Most of the information is presented in the
body. The body contains facts, arguments or concepts that have been presented during
the introduction. The content in the body should progress coherently and logically. The
first part should be a broad overview of the topic followed by detailed concepts to
enable the students understands the concepts that will be provided.

Conclusion

This includes a compelling and carefully selected take-home message for the students to
remember. This must be brief and succinct, that is clear and must cover the aspects of
the content. In the conclusion, encourage the students to read further. Below is a
summary of basic organisation of a lecture.

Tip
When preparing and delivering a lecture, consider the following:
 Introduction
o Purpose
o Introductory comments
o Ground rules of the lecture
 Body
o Arguments and concepts
o Key concepts first
o Competing and controversial topics later
 Conclusion
o Question and answer
o Brief and succinct take-home message
o Further reading

Ways to Make Lectures More Learner-Centred

Periodic Pause and Review

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Allow learners to have periodic short breaks every 10-15 minutes interval, especially if
the lecture period is long. During the pause, learners can work in pairs to review,
discuss, and revise their notes. This allows learners to assimilate, clarify and strengthen
their newly learned information.

Carefully Crafted Questions and Answer

Use of questioning during lectures helps to promote active thinking. The idea of
questioning is not to test the knowledge of students but to bring their attention to
specific points, and generally encourage them into thinking. Questioning should be done
throughout the lecture period.

In summary, to make your lectures more interactive:

 Maintain good eye contact. As you speak, shift your gaze about the class, pausing
momentarily to meet the gaze of each learner. Make the learners feel what you
have to say is directed to each one personally.

 Watch for indications of doubt, misunderstanding, a desire to participate, fatigue,

or a lack of interest.

 Maintain a high degree of enthusiasm.

 Speak in a natural, conversational voice.‘ Enunciate your words clearly. Make

certain the learners can hear every spoken word.

 Emphasize important points by the use of gestures, repetition, and variation in

voice inflection.

 Check learner comprehension carefully throughout the presentation by watching

the faces of the learners and by questioning. Observing facial expressions as an
indication of doubt or misunderstanding is not a sure way of checking on learner
comprehension. Some learners may appear to be comprehending the subject
matter when, in reality, they are completely confused. Learners who are in doubt
often hesitate to make their difficulty known.

 Frequently ask if the class has any questions, thus giving the learners an
opportunity to express any doubts or misunderstandings on their part.

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 Based on your personal knowledge and past experiences, ask specific questions
about those areas which might give learners the most trouble.

5.4 Guided Discussion

Guided discussion is a method in which the students and the instructor exchange their
ideas in order to get a better understanding of a topic. It can be a whole period or be a
part of a lesson. The discussion method, when used properly, is a good way to stimulate
thinking on the part of the student. It can be used to advantage when the students have
background knowledge of the subject being discussed. The instructor should prompt
everyone to take part, thus allowing the students the opportunity to learn from everyone
in the group. The discussion method is interaction centered and can be teacher or
student centered, and can be held in either a large or small group. Interaction techniques
capitalize on the human desire to talk and share one‘s thoughts. Personal activity
permits greater involvement in the lesson. Good discussions give students an
opportunity to formulate principles in their own words and to suggest applications of
these principles; they help students become aware of and define problems implied in
readings or lectures; they can also increase students‘ sensitivity to other points of view.

Characteristics of Discussion Method

1. Expands the cognitive and affective domains of students.

2. Can be used to solve problems and develop interest in the topic.

3. Emphasizes main teaching points.

4. Utilizes student knowledge and ideas.

5. Results in more permanent learning because of the high degree of student

involvement.

6. Determine student understanding and progress.

7. Everyone has a chance to get involved.

8. Teaches how to come to an agreement within a group without arguing.

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Challenges of the Discussion Method

1. Tend to get off topic if the instructor doesn‘t continually redirect ideas.

2. More informed and eager students tend to monopolize the discussion.

3. Not suitable for presenting information for the first time.

4. It is not very effective in describing procedures or breakdown of a component.

5. Content is limited and the method is time consuming.

6. It restricts the size of groups.

7. The larger the groups the more difficult it is to guide the discussion.

Preparing for Discussions

(Middendorf and Kalish, 1994)

Decide How Much Time You Want to Spend

Decide if you want this discussion to be a five-minute break in the middle of a lecture,
or two minutes at the beginning of class to be sure they read the assignment. You may
also spend the entire class period having the students develop their own ideas. Any of
these might be appropriate, depending on what your goal for the discussion is.

Develop a Clear Goal for the Discussion

Knowing the content to be covered is not enough. You should be able to articulate what
the students will be able to do with the information or ideas.

Problematize the Topic

Having a clear goal in mind makes it much easier to plan a discussion. You know what
you want students to get out of it. This goal must be presented in a problem form. Give
your students an open-ended problem to solve, a task to complete, a judgment to reach,
a decision to make, or a list to create—something that begs for closure.

Select an Activity to Frame the Problem

Many discussion activities can be used in the classroom. It is important to choose one
that will help your students meet your goals for the discussion. The more specific you
can be in assigning the task, the more likely your students will be to succeed at it. Some

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possible tasks are as follows: Think-Pair-Share, brainstorm, buzz groups, case analysis
and role-playing.

Choose a Grouping Method

Vary groups by size, method of selection, and duration.

 By size: Two to six participants is ideal. Smaller groups (two-three) are better for
simple tasks and reaching consensus. Also, students are more likely to speak in
smaller groups. Larger groups of four-five are better for more complex tasks and
generating lots of ideas.
 By selection: Randomly assigning students to groups avoids the problem of
friends wanting to get off track. For long-term groups, you may want to select for
certain attributes or skills or by interest in the topic, if different groups have
different tasks.
 By duration: Just for this activity or for all semester. Stop the discussion groups
while they are still hard at work; next time, they will work doubly hard. Long-term
groups allow students to practice collaborative skills and make stronger bonds, but
sometimes they get tired of each other.

Choose a Debriefing Method

Many techniques can get students to share what their smaller groups have done with the
entire class: verbally, on newsprint/flipchart, blackboard or power point etc. You do not
have to hear from everyone; calling on a few groups at random to report works quite
well.

Always debrief students; it is the most important part of a discussion, the time to
summarize and synthesize. Most of learning in discussions happens during debriefing,
so don't squeeze it in—a rule of thumb is to use one-third of the total discussion time for
debriefing.

You can use debriefing to correct incorrect notions. You can slip in any points that
students neglected but that are important. You can pick which student reports from each
group, though you should tell them in advance that you plan to do this. This makes
everyone in the group responsible. You don‘t have to hear from every group, but can
instead choose a few at random. When groups start repeating ideas, it‘s time to stop.

Preparing for a Discussion

Planning for a lesson wherein you intend to use the GUIDED discussion method is
basically the same as planning for a lesson using the lecture method. Generally, before
you decide to use the guided discussion, you must consider the objectives rather
carefully. You must also consider your students to determine whether they have the
knowledge required to exchange and build on to arrive at an achievement of your
objectives.

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Your first step is to establish specific, student-centred, behavioural objectives. The

discussion leader must be very well informed about the objectives. Organize your main
teaching points and your subordinate points in a logical sequence and plan at least one
lead-off question per teaching point. It is also wise to anticipate some of the material
you will get from your students and plan follow-up questions for areas where you feel
difficulties could arise.

Leading the Discussion

Careful planning makes the presentation straightforward. The introduction to the guided
discussion lesson is standard, having only the added responsibility on your part to try to
create the atmosphere necessary to good discussion. As part of the motivation, you can
remind the students that it is their responsibility to contribute.

During the discussion questions are the key. These must be planned and organized
carefully for continuity, direction and control. The nature of the questions you plan will
be determined by the objectives. Avoid questions that ask for only short answers the
―who‖ or ―when‖ type. Ask broad question, the ―why‖ or ―how‖ type. You must be
prepared to guide the discussion along any track, so long as the discussion still remains
profitable in view of your objectives. Once you begin to put off the track, the thing to do
is for you to halt the discussion, provide a summary of valid points made to date, then
provide a new leading question that will put the discussion back on the rails.

Visual aids may be used during guided discussion just as in any other lesson. You may
find the chalk or white board a very flexible and useful aid for interim summaries as the
development of material progresses during the discussion. Flip charts may also be put to
good use. Other types of visual-aids like films transparencies, tapes, etc. can be very
useful in providing background information.

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Concluding

Concluding the guided discussion may take several forms. Depending on what method
of evaluation you selected, you may wish to provide an oral or written test before
finalizing. Generally, you must summarize the main ideas developed by the students
during discussion, and relate them firmly to the objectives. Let your students know what
they accomplished and praise them, as they deserve. During guided discussion lessons,
you must be aware of individual personalities among your students. Encourage the
considerate, rebuke the rude, and emphasize the worth of individual thought no matter if
the thought does not happen to border on genius. Boost the shy student into the
discussion; hold back the brash one who would take over. As for all other forms of
instruction, thorough personal preparation is the key to success.

Summary

The discussion method has highly valuable side benefits in that it promotes reflective
thinking, improves self-expression social attributes, and encourages group thinking and
cooperative effort. While it is generally thought to be most useful in teaching
abstractions, it can, for example, be useful in teaching technical material as well, if there
is sufficient student background knowledge to make discussion worthwhile.

5.5 Role-Play
Role-play is the re-enactment of situations, which students face, they are likely to face
in future or which they perceive to be job-like (DMED, 2007). Through such re-
enactment students can re-examine previous behaviour, try out behaviours they have
just acquired, or experience with behaviours that strike them as potentially useful.

Role-playing offers several advantages for both teacher and student. There is increased
involvement on the part of the students in a role playing lesson. In role playing, students
are not passive recipients of the instructor‘s knowledge but take an active part.

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Role plays also teach empathy and understanding of different perspectives (Poorman,
2002). A typical role playing activity would have students taking on a role of a
character, learning and acting as that individual would do in the typical setting. The use
of role-playing emphasizes personal concerns, problems, behavior, and active
participation and it improves interpersonal skills, and improves and enhances
communication skills.

The role-playing approach can be used in a variety of settings, including the classroom.
The principle behind role-playing is that the student assumes a particular personality of
a different person, such as a historical character.

Role playing activities are divided into four stages (Cherif & Somervill, 1998):

1. Preparation and explanation of the activity by the teacher

2. Student preparation of the activity

3. The role-playing

4. The discussion or debriefing after the role-play activity

Advantages of Using Role-Play

The educational advantages from using role-play in teaching include the following:
 It encourages individuals, while in role, to reflect upon their knowledge of a
subject. As such, role-play is an excellent teaching method for reviewing material
at the end of a course of study.
 Individuals are required to use appropriate concepts and arguments as defined by
their role. As roles change, so might relevant concepts and arguments. Students
may come, as a consequence, to appreciate more fully the relevance of diverse
opinion, and where and how it is formed.

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 Participation helps embed concepts. The importance of creating an active learning

environment is well recognized if the objective is one of deep, rather than surface
learning. Role-playing can make a valuable contribution in this process.
 It gives life and immediacy to academic material that can be largely descriptive
and/or theoretical.
 It can encourage students to empathize with the position and feelings of others -
something that, in the normal process of teaching, is likely to be missed.

Disadvantages of Role plays

 Role plays can be frightening, especially for the shy participants
 Requires careful planning and managing
 Can take some time to prepare
 May be difficult to manage

5.6 Seminar
This is where participants research a topic, presents the findings to other participants
and leads the ensuing discussion.

Problem Based Learning (PBL)

PBL is a student-centered pedagogy in which students learn about a subject in the

context of complex, multifaceted, and realistic problems (Hmelo-Silver, 2004). The
goals of PBL are to help the students develop flexible knowledge, effective problem
solving skills, self-directed learning, effective collaboration skills and intrinsic
motivation. Working in groups, students identify what they already know, what they
need to know, and how and where to access new information that may lead to resolution
of the problem. The role of the tutor in PBL is that of facilitator of learning who
provides appropriate scaffolding and support of the process, modeling of the process,
and monitoring the learning. The tutor must build students confidence to take on the
problem, encourage the student, while also stretching their understanding (Barrett,
2010).

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Advantages
 Group is given common body of information
 Very useful with advanced group of students
 Enables teacher present to students a large body of
information in relatively short period of time
 Allows for the spontaneous student responses and questions
and thus points can be clarified as they are raised by the
students
 Easy to direct and control

Disadvantages
 Limited teacher/student interaction needed for proper
evaluation of instructional process
 A relatively passive form of learning
 Limited use in the teaching of skill work
 Aimed at average ability
 Fosters unquestioning acceptance of present material
 May not capitalize on student curiosity or creativity
 Tends to centre more on content than on what students are
able to do
 There is limited use of teaching skills

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5.7 Educational Media

This is a means of communication. Media encompasses anything carrying information between
source and receiver. It encompasses a number of tools. Educational media/audio-visual aids can be
defined as a support to teaching strategies which assist learning (Reece and Walker, 2000). They are
sensory objects or images which initiate or stimulate and reinforce learning. Subjects can be taught
effectively through appropriate use of learning aids.

Value of Educational Media

 Motivation- motivates and stimulates students to learn easily

 Curiosity- due to variety in teaching aids

 Students are able to manipulate their learning environment and interest is sustained.

 Provides real life experiences and makes learning meaningful

 Help the teacher clarify, establish, correlate and coordinate accurate concepts

 Teacher must ―show: as well as ―tell‖

 Decrease abstractness of spoken and written words and makes learning concrete.

 Attention is increased.

Classifications of Educational Media

 Can be classified in different ways

 Projected and non-projected media e.g overhead projector, slides, LCD.

 Audio materials, visual materials and audio-visual materials

 Big media (computer, VCR and TV) and little media (radio, films strips)

 Three-dimensional aids (specimens)

Types of Educational Media

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1. Visual Aids e.g. Chalk board, posters, bulletin board, displays, pictures

2. Auditory Aids- use hearing e.g. radio, recordings

3. Audio-visual Aids- motion pictures, slides and Television.

4. Simulation devices

Characteristics of Good Educational Media

• Meaningful and purposeful

• Accurate in every respect

• Simple

• Cheap

• Large enough and properly seen by the students for whom they are meant.

Factors affecting choice of educational media

 Subject matter and required student performance and teaching strategy

 Types of learning task

 Teaching space, lighting system, facilities.

 Teachers attitude and skills

 Practical design constraints

 Target population size

 Available resources

Commonly used Educational Media

 Overhead Projector

 Computer/LCD

 Boards

 Flip Charts

 Video

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Evaluation of Educational Media

 Were the objectives of the lesson accomplished?

 Was enough time given to the use of teaching aids

 Were the teaching aids used at the right moments?

 Did the teacher use handle the aids well?

 Were the students apparent reactions positive towards the media?

Information Technology

IT teaching and learning empowers faculty, other staff and students. IT promotes life-long learning
and to apply that knowledge for their benefit and that of community. IT Methods in Nursing education
includes computer, internet (CAL) which can be used for electronic mailing, tutorials and group work,
E-learning, podcasting (digital Sound Recording) and intranet (e granary and moodle).

“a picture is worth a thousand words”.

Unit Summary

Summary
 In this unit, you have different teaching methods that can be used
to facilitate learning of concepts. The methods selected must be
those that facilitate active participation of students. As a teacher
you should know the limitations of each method selected so that
you know how to help your students learn.
 We have also covered educational media in education.
Instructional or educational media are a means of helping the
teacher achieve his or her best. The greatest value of Instructional
media lies in their appeal to senses, ability to attract and hold
attention, and their ability to focus the attention on essential
elements to be learned at the proper time
 Congratulations for completing unit 5 successfully! This
means that you are now ready to advance to unit 6 which focuses
on Clinical teaching.

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Unit 6: Clinical Teaching and Learning

Introduction
In unit 5, we discussed that various principles and concepts that relate to teaching and
learning and how we can use these methods to facilitate the acquisition of knowledge, skills
and attitudes. This unit begins with a brief overview of clinical teaching and learning
followed by a discussion on the commonly used approaches in clinical nursing education and
how to select these approaches.

Aim
The unit aims at equipping you with knowledge and skills in selection and use of appropriate clinical
teaching and learning approaches to facilitate learning of clinical skills.

Objectives

At the end of the unit, you should be able to:

1. Explain the importance of clinical teaching in nursing education
2. Describe the clinical teaching strategies
3. Plan the clinical teaching programme

Time Required
To study this unit, you require 4 hours

6.1 Definition
Clinical teaching can be defined as teaching and learning focused on, and usually
directly involving patients and their problems (Spencer 2003).

Clinical (klinikos) is term that also means bedside. Being taught the theory of nursing in
the classroom enables the student to learn, assimilate and store knowledge for future use
and to apply it in the nursing care of patients and clients. A nurse must be able to put
into practice what she has learnt. Clinical teaching occurs in the real life situation and

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translates theory into reality. The student is an active participant and clinical teaching is
also a small group activity.

In clinical teaching, the student is given an opportunity to develop self confidence by

performing under expert guidance. It also affords the student opportunities for
observations and decision making. Clinical teaching centers around patient care. In the
clinical setting, nursing care becomes a reality and the nurse can observe the responses
of patients to illness and nursing care. The teacher guides, supports, stimulates, and
facilitates learning. The teacher facilitates learning by designing appropriate activities in
appropriate settings and allows the student to experience that learning.

Clinical practice requires critical thinking, problem-solving abilities, specialized

psychomotor and technological skills, and a professional value system. Clinical
teaching is the means by which students learn to apply the theory of nursing. It involves
the integration of theoretical knowledge and practical skills.

Interactive Learning in the Clinical Context

Student

Content

Teacher Patient

Aim of Clinical Teaching

The aim of clinical teaching in nursing education is to produce competent nurses
capable of giving expert nursing care which is based on sound knowledge and practiced
skill. Clinical teaching is an integral part of providing patient care.

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6.2 Educational Characteristics of Clinical Teaching

Patient-centeredness
This is the most important and it is also important to note that patients form the basis of
the content.

Encounter specificity
Clinical teaching is specific to a particular encounter.

Unpredictability
Learning experiences in the clinical area may not be predetermined.

Constraint of time
There is always time constraint and this is the major challenge in clinical teaching.

Clinical reasoning
This is a process of making decisions about various aspects of disease and health of the
patients.

6.3 Knowledge Bases of Successful Clinical Teaching

Knowledge of the subject matter

As a clinical teacher, you should have the requisite knowledge of the subject matter.
Successful clinical teaching requires that you reorganize and restructure the knowledge
of the subject according to the needs of specific teaching purpose.

Knowledge of the context

Effective clinical teaching requires that you possess insight and knowledge of the
contexts about the patient and practice, for example you need to know the nature of the
patient population served by the hospital and the site where you are conducting the
clinical teaching.

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Knowledge of the patients

Good clinical teachers must have elaborate understanding of the patient who is being
discussed during the clinical teaching session.

Knowledge of the learners

As a clinical teacher, you should also have extensive knowledge about the learners, their
needs, deficiencies and strengths. This will help you in mentoring and coaching them.

Knowledge of the general principles of teaching

It is also important that you are conversant with the general principles of teaching and
learning.

6.4 Skills Taught in the Clinical setting

There are several skills that can be taught in the clinical area. Some of these include:
 Technical skills based on knowledge and practice
 Observational skills
 Critical judgment
 Responsibility for the care of clients
 Attitudes, norms and values appropriate behaviour in a variety of situations
 Planning to promote, maintain, restore optimal functioning of the patient
 Implementation of the nursing care plan
 Evaluation skills

Settings for Clinical Teaching

The clinical environment consists of inpatient, hospital outpatient, home and
community settings and each of these can be a site for clinical teaching.

6.5 Clinical Teaching Strategies

There are various teaching methods that you can use in clinical teaching. Some of them
include:
 Demonstrations

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 Simulations
 Case discussions
 Ward rounds
 Peer group teaching
 Writing and giving reports
We will not discuss all of them in detail. We will only discuss those that are common in
nursing education including demonstration, simulations, and case presentations.

Demonstration
Demonstrations are done for the purpose of showing students how to do various actions
such as:
 Showing students how to carry out a nursing technique which is completely new
to them.
 Illustrating the application of fundamental scientific principles to the process of
nursing.
 For the purpose of demonstrating techniques which are to replace those currently
in use. This may or may not include the use of new equipment.
 Showing students in a practical manner how to achieve a sound nurse-patient
relationship when carrying out patient care.
(Mellish et al, 2008)

When doing a demonstration, the teacher performs some process of a skill or

phenomenon while the students watch and later practice. Demonstrations can be used to
illustrate interpersonal skills such as interviewing, communication, discipline or
counselling.

Guidelines for Demonstration

As you demonstrate the procedure, advance from the known to unknown as new
knowledge and skill are constructed upon pre-existing knowledge and skill. You should
emphasize the knowledge and attitude component of skills. It is important that you
practice and teach safer aspects of the procedure first and also allow learners sufficient

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time to be familiar with the equipment. Always be cognizant of learner‘s ability and
needs.

Preparation
1. The procedure must be well planned so that the steps are followed logically. You
should identify the key points and relate theory underpinning key point.
2. Select the patient simulation situation.
3. Determine objectives
4. Ensure that all equipment is available and in good working order. You should
assemble and test the equipment before you begin.
5. Practice the technique.
6. Consider how you would divide your class if it comprises more than 10 students.
7. Time your demonstration by going over it before presenting it to the students.
8. Ensure that the students have the necessary knowledge of the procedure. The
theory component must be taught before the procedure is demonstrated.
9. Consider how you would emphasize aspects of safety.
10. Plan summary and questioning sessions.

Presentation
1. The teacher must be competent and must understand the underlying theory.
2. Before you begin the procedure, check existing knowledge of students. Explain to
the students the objectives, as well as what is to follow and the special points to be
observed. If the procedure is being done on the patient, tell the students to ask
questions after the procedure and to avoid making remarks or observations that
may cause anxiety in the patient.
3. Give a clear introduction.
4. Name the equipment clearly
5. Do not show how not to complete the skill
6. Stress key points, ask questions and allow questions.
7. Observe essential safety precautions.

Teaching Procedural Skills (Psychomotor Domain Based Model

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(George and Doto, 2001)

Steps Rationale Preceptor’s Task

1. Students master the Understanding the Teaches the knowledge

cognitive components of necessities of the skills components of the
the skills such as motivates the learners procedure
indications, principles
2. Preceptor demonstrates Learners develop visual Demonstrates procedure
the exact way the impression of the to the learners with or
procedure is done procedure without the help of
without verbal mannequins
descriptions
3. Preceptor repeats the Learners chance of Repeats the procedure
procedure and describes success improves if again. Narrates the steps
each step they are able to narrate
the procedure
4. Learners sequentially Builds up the memory Listens to the students
describe the steps to the of the procedure. describing the procedure.
preceptor Allows preceptor to Corrects and reinforces if
correct the learner necessary
5. Learners perform the Learners are ready to Preceptor observes and
procedure demonstrate the provides feedback.
procedure Allows the student to
repeat the procedure until
desired proficiency is
achieved.

Advantages of Demonstrations
1. When performed well, the demonstration can be motivating to students.
2. Demonstrations also link theory and practice.
3. Expert and professional demonstrations can be obtained through pre-prepared
videos.
4. Key points can be stressed and repeated.
5. Students see the sequence and build up.
6. Allows students to ask questions.

Problems with demonstration

1. A poor demonstration can be frustrating for the students
2. Can be too fast or too slow for the students
3. There is no permanent record kept

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4. May be difficult to see

5. May be too long leading to loss of concentration
6. If not properly handled, students may learn bad habits/techniques
7. Can be expensive in terms of material costs
8. Students can be passive

Simulation
Simulation is the process of designing a model of a real system and conducting
experiments with this model for the purpose of either understanding the behavior of the
system and/or evaluating various strategies for the operation of the system.

Purposes of Simulation
 To help students practice decision-making and problem-solving skills and to
develop human interaction abilities in a controlled and safe setting.
 Through active involvement in a simulation exercise the student achieves cognitive,
affective and psychomotor outcomes.
 Students have a chance to apply principles and theories they have learned and to see
how and when these principles work.

Uses
 Simulation technique can be used to achieve many learning objectives.
 Simulations can help nursing students gain skill in applying the nursing process for
example they can practice gathering and analysing data, setting priorities, setting
and evaluating outcomes.
 Learn to solve problems efficiently with minimal wasting of time and resources.
 In the acquisition of communication skills for instance students can put themselves
in the shoes of others such as patients, families, co-workers, supervisors etc and
learn something about these people‘s feelings and how to interact effectively with
them. They get immediate feedback about how they affect other people.
 Simulation is also an avenue for attitude change.
 Simulation technique can be applied to the learning of psychomotor skills.

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 Simulation is used to evaluate the student learning and competence for example
examinations can be conducted in simulation.

Tip What can we Simulate?

1. Technical skills
2. Psychomotor skills
3. Adherence to safety measures
4. Non technical skills
5. Decision making
6. Cognitive rehearsal
7. Teamwork
8. Situational awareness
9. Communication

Steps in Simulation (Devi, 2006)

Step 1: The teacher must assign letter (A, B, C) designation to all the members of the
group and develop a system of rotating the role assignment by letters so that each
individual has the opportunity to participate and as a chance to be actor, foil and
observer.

Step 2: Includes planning, preparation and deciding the topic of the skill to be practiced
through simulated technique. The teacher should carefully and intelligently select an
appropriate topic for each actor according to his knowledge and interest in the subject.

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Step 3: the teacher should decide in advance as regards the name of the member of the
group who will start the conversation. A detailed schedule for actor interaction should
be drawn.

Step 4: The teacher should decide the procedure of evaluation and decide on what kind
of data the observers are record and who their data and opinions can best be presented
to the actor when the interactions stops.

Step 5: Conduct the first practice session on a topic or skill you decide. Provide the
actor with feedback on his performance and be prepared, if necessary, to alter the
procedure for the second in order to improve the training procedure. As soon as the
practice sessions are working smoothly and each person has an opportunity to be actor,
increase the difficulty of the task by privately instructing the foils or restricting the
instructor‘s role.

Step 6: This is the last step in simulation. Now the teacher should be prepared to alert
the procedure, change topic and move on the next skill so as to prevent a significant
challenge to each actor and to keep interest as high as possible. The task should be
neither high nor too easy for the participants.

Debriefing
Feedback through debriefing is considered one of the most important components to the
effectiveness of simulation-based learning. It helps participants to reflect, fill in gaps in
performance and make connections to the real world. As for instructors, simulations
help them to reflect. It is important that immediately after the simulation, you briefly
summarise what has taken place. Students must be encouraged to reflect and analyse
what they did to help them gain insight into why they made certain decisions or acted
the way they did. At the end of the discussion period you should point out how
principles and concepts have been applied and how the experience ties in to the learning
objectives.

Advantages of Simulation

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 It reduces the complexities of real life simulations to a level that can be dealt with
by beginners.
 By controlling some variables, the situation is still close to reality. The student is
not overwhelmed and can concentrate on reacting to a few variables at a time.
 Simulation provides a safe learning environment because they are structured and all
possible mistakes would be made and students would never make those same
mistakes in the real world. Therefore patient safety is not compromised.
 The students may be able to transfer the learning to real clinical settings.
 It encourages creative and divergent thinking.
 Simulations are student-focused.
 Simulations can be repeated and rare situations can be replicated.
 Immediate structured feedback is given.
 Observers can learn almost as much as participants (need activity during
simulation)

Disadvantages of Simulations
 Simulation is costly in terms of both time and money.
 Simulation techniques consume a lot of classroom time.
 The processes and outcomes of simulation methods are not always predictable.

Reflection
Reflection on one's performance is critical for learning. Depending upon the level of the
student, they may need more time to reflect on the clinical details to understand how it
all fits. Students need to take the information, think about it, integrate it, and apply it to
the appropriate patient or scenario. In giving the student time to reflect it is imperative
for them to be able to generalize information and to develop the crucial critical thinking
skills necessary for more independent practice.

Case Presentation
Case Presentation allows for the student to obtain crucial information, apply it, generate
reasonable assumptions about the problem and develop a plan of action (Burns et al.,

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2006). It allows the instructor to assess the student's level of critical thinking and the
ability to transfer previous experiences into new clinical situations. Cases may be
selected because they are complex, interesting and are based on the learning goals.
Students can be divided in teams and a clinical case is selected by the team. The
instructor points out some aspects of the case, asks the team to generate nursing
diagnoses for the case. How each of these steps is done determines the effectiveness of
the teaching conference.

The case is then presented in a session based on the goal of the session.

Micro-skill Model for Case Presentation

Getting a commitment
After a student has presented a patient case to you ask them for any additional
information if you do not feel comfortable about what they have presented.

Probe for supporting evidence

After the student has made a decision about the patient case, ask her/him to explain how
they arrived at that decision. This is done to evaluate the learner‘s knowledge and
reasoning.

Teach general rule.

Students can never treat every kind of patient they will see later in their practice.
Therefore, it is imperative that students learn how to transfer information from a
specific patient to a general category of patients.

Reinforce what the student did right

Give positive feedback to assure them that what they did was the appropriate action for
the patient.

Correct mistake

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Just as it is important to reinforce correct behavior it is equally important to correct

student mistakes. Provide constructive feedback with recommendations for future
improvement.

Qualities of an Effective Clinical Teacher

An effective Clinical teacher must:
 Be a skilled practitioner of nursing.
 Have up-to-date theoretical background-through reading, enquiry, and attending
up-to-date lectures, courses symposia etc.
 Instill confidence into those she/he is teaching.
 Have a flexible attitude so that they are able to evaluate, adopt, adapt or reject
nursing care.
 Maintain high professional standards, honesty, integrity and objectivity.
 Have the ability to interpret norms and values of the profession.
 Be resourceful so that unforeseen occurrences are dealt with calmly and
constructively
 Have knowledge of the resources available in the hospital and community for
them to advise the clients appropriately.
 Have excellent interpersonal relationships.
 Be able to manage time well.
 Be approachable
 Place high value on human life and dignity

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Unit Summary

Summary
 In this unit, you have studied clinical teaching which is the most
important and most complex aspect of nursing education.
Several methods can be used in clinical teaching.
 The challenge is choosing the best method that is effective
when teaching large numbers of students.
 Most clinical teaching methods focus on a critical-thinking
discussion between student and preceptor, and a brief
exploration of diagnostic or management options.
 Congratulations for completing unit 6 successfully! This
means that you are now ready to advance to unit 7 which focuses
on measurement and evaluation.

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Unit 7: Measurement and Evaluation of Learning

and Teaching

Introduction
In unit 7, we will discuss various concepts and principles regarding measurement and
evaluation of learning. The unit begins with a brief overview of approaches to testing
followed by concepts that relate to assessment. We also discuss different techniques that we
use to assess learning achievement. This is an important aspect ot nursing education because
quality in assessment is vital.

Aim
The unit aims at equipping you with knowledge and skills in assessment of student learning.

Objectives

At the end of the unit, you should be able to:

1. Outline the principles of assessment
2. Explain the purposes of assessing students
3. Describe the methods/techniques of assessment
4. Outline Validity and Reliability in Assessment

Time Required
To study this unit, you require 6 hours

7.1 Approaches to Assessments

Measurement
Measurement is a process by which the attributes or dimensions of some physical object are
determined. It is a set of procedures and the principles on how to use the procedures in educational
tests and assessments. Measurement answers the question, ―How much?‖

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Evaluation
These are procedures used to determine whether the subject (i.e. student) meets preset criteria, such
as qualifying for special education services. Evaluation uses assessment (an assessment may be a
test) to make a determination of qualification in accordance with a predetermined criteria.

Assessment

Assessment is a process of gathering information to monitor progress and make educational

decisions if necessary. An assessment may include a test, but also includes methods such as
observations, interviews, behavior monitoring, etc.

Test

A test is a method to determine a student's ability to complete certain tasks or demonstrate mastery
of a skill or knowledge of content. Some types would be multiple choice tests, or a weekly spelling
test.

Therefore….

 A Test is used to gather information.

 That information is presented in the form of measurement.

 That measurement is then used to make evaluation.

As you can see from above, although these terms measurement, evaluation, assessment and testing
are used interchangeably, they are quite different. In this module we shall concentrate on
assessment.

Assessment is an ‗estimate of the learner‘s knowledge, skills and attitudes in relation to

predetermined criteria of competency‘ (Bradshaw, 1989).
Assessment is the systematic collection and analysis of information to improve student learning
(Stassen, Doherty and Poe, 2001).
Assessment for learning occurs throughout the learning process. It is designed to make each
student‘s understanding visible, so that teachers can decide what they can do to help students
progress. Classroom assessment is both a teaching approach and a set of techniques. The approach
is that the more you know about what and how students are learning, the better you can plan
learning activities to structure your teaching.

Assessment is interactive, with teachers because it helps in:

 Aligning instruction with the targeted outcomes

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 Identifying particular learning needs of students or groups

 Selecting and adapting materials and resources
 Creating differentiated teaching strategies and learning opportunities for
 Helping individual students move forward in their learning
 Providing immediate feedback and direction to students

7.2 Purposes of Assessment

There are several purposes or reasons why teachers assess the learners including the
following:
 Determines the effectiveness with which a body of knowledge has been communicated by
the teacher to the student.
 Provide data about the effectiveness of the curriculum.
 Serves as a source of feedback to the student about the progress being made.
 Acts as a motivator for students
 Assessment provides teachers with information to modify and differentiate teaching and
learning activities.
 Provides teachers with information to determine what students know, to gain insights into
how, when, and whether students apply what they know.
 Teachers can also use this information to streamline and target instruction and resources,
and to provide feedback to students to help them advance their learning.
 Students monitor their own learning and use the feedback from this monitoring to make
adjustments, adaptations, and even major changes in what they understand.
 Demonstrates whether students have achieved the curriculum outcomes

7.3 Planning for Assessment

When planning for assessment, it is vital that you ask the following questions.
 Why am I assessing?
 What am I assessing?
 What assessment method should I use?
 How can I ensure quality in this assessment process?
 How can I use the information from this assessment?
These questions must be answered so that you have the right reasons and not just punishing the
students and also that you ensure quality in your assessment.

7.4 Principles of Assessment

The primary purpose of assessment is to improve student performance

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Every good assessment must set out to measure what matters most. Assessment should not be aimed
at trivializing issues or punishing students for not attending class but to improve performance.

Assessment should be based on an understanding of how students learn

Assessment is most effective when it reflects the fact that learning is a complex process that is multi-
dimensional, integrated and revealed in student performance over time.

Assessment should be an integral component of course design and not something to add afterwards
The teaching and learning elements of each program should be designed in full knowledge of the sorts
of assessment students will undertake, and vice versa. Do not only think of assessments after the
course has been designed.

Good assessment provides useful information to report credibly to stakeholders on student

achievement
A variety of assessment methods provide teachers with evidence of what students know and can do,
and their particular strengths and weaknesses.

Good assessment requires clarity of purpose, goals, standards and criteria

Assessment criteria need to be understandable and explicit so students know what is expected of them
from each assessment they encounter.

Good assessment requires a variety of measures

A single assessment instrument will not tell us all we need to know about student achievement and
how it can be improved. Proper use of assessment methods requires an awareness of their limitations.

Assessment methods used should be valid, reliable, authentic and consistent

Assessment instruments and processes should be chosen which directly measure what they are
intended to measure.

Assessment requires attention to outcomes and processes

Information about the outcomes students have achieved is very important to know where each student
ends up.
Assessment works best when it is ongoing rather than episodic
Assessment is a means to an end, not an end in itself. It should not be a one time off or something that
is done once in awhile, but should be an ongoing process.

Assessment for improved performance involves feedback and reflection

All assessment methods should allow students to receive feedback on their learning and performance
so assessment serves as a developmental activity aimed at improving student learning.

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7.5 Types of Assessments

Summative Assessment
The purpose of summative assessment is to provide "a sampling of student achievements which lead
to a meaningful statement of what they know, understand and can do" (Brown & Knight, 1999, p.37).
Summative assessment is used to evaluate the effectiveness of instructional programs and services at
the end of an academic year or at a pre-determined time. It also helps to make a judgment of student
competency after an instructional phase is complete and to find out if students have mastered specific
competencies and to identify instructional areas that need additional attention.

Formative Assessment

On the other hand, formative assessments are on-going assessments, reviews, and observations in a
classroom. Teachers use formative assessment to improve instructional methods and student feedback
throughout the teaching and learning process. E.g if a teacher observes that some students do not grasp
a concept, she or he can design a review activity or use a different instructional strategy.

Students can monitor their progress with periodic quizzes and performance tasks. The results of
formative assessments are used to modify and validate instruction. Results of formative assessment do
not contribute to a student's final grade but are purely for the purpose of assisting students to
understand their strengths and weaknesses in order to work towards improving their overall
performance. Formative assessment has the potential to highlight areas in which teaching and
curriculum design needs to be improved as well as any areas where teaching methods have been very
effective in improving student performance. To be successful, feedback needs to be immediate and
identify the way forward. It should not simply tell learners whether their answers are right or wrong,
or simply provide evaluative feedback in the form of grades and short, non-specific comments of
praise or censure.

Types of formative and Summative Assessments

Formative Assessment Summative Assessment

Observations during in-class Examinations (major, high-

activities stakes exams)

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Homework exercises · Final examination

Reflections journals reviewed Term papers

periodically during the semester

Formal and informal question Projects

and answer sessions

In-class activities Portfolios

Student feedback Student evaluation of the course

(teaching effectiveness)

Conferences between the Instructor self-evaluation

instructor and student

7.6 Interpretation of Test Scores

Best practice in grading in higher education involves striking a balance between criterion-referencing
and norm-referencing.

Norm Referencing

Norm-referenced assessment is to rank the performance of students in a particular group in order to

generate a final grade. It involves fitting of the marks of students to a normal distribution (or 'bell
curve') using a qualitative or statistical technique, allowing the assessor to re-interpret students' marks
after the assessment has taken place (James, 2002). The resulting normal distribution is then used to
allocate grades to students based on a pre-determined proportion of grades. This means that the
quantity of each grade awarded to students can be standardized from year to year. The method of
distributed grades is based on the assumption that the performance of student groups is always
roughly the same and can therefore be validly placed in such a normal distribution.

Criterion referencing

Criterion referencing method involves "determining a student's grade by comparing his or her
achievements with clearly stated criteria for learning outcomes and clearly stated standards for
particular levels of performance" (James, 2002). By explicitly setting out the criteria for an

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assessment, this clarifies not only what is required of students but also assists instructors in
determining what they need to teach. Criterion referencing can also improve the reliability of feedback
offered to students as the criteria serve as points of reference for instructors to use when grading
students' work (Knight, 2001, p.18). In criterion-referenced assessment particular abilities, skills or
behaviours are each specified as a criterion which must be reached. E.g. our criteria is 50%, if a
student scores 56% they have met the criteria and thus passed.

7.7 Methods/Techniques of Assessment

There are several assessment methods that can be used in nursing education. The common one are:

 Multiple choice questions (MCQ)

 True-false Test Items

 Short answer questions

 Essays

 Modified Essay questions

 Performance assessment

 Competence assessments (Objective Structured Clinical Examination (OSCE), Patient

Management Problems)

We will discuss a few of these in a little bit more detail.

Multiple Choice Questions (MCQ)

MCQ is a question in which students are asked to select one alternative from a given list of
alternatives in response to a "question stem". MCQs are used to test a student's ability to recall
information, interpret data or diagrams, analyse and evaluate material.

Multiple-choice questions are easiest to write when there is a definitively right or wrong answer

Activity 7.1
For the next 5 minutes before you read further, take your notebook and write down the strengths
and weaknesses of MCQs.
Compare your answers to those given at the end of the unit

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Writing Good MCQs

General Strategies

 Write questions throughout the term/semester.

 Questions demanding high-level thinking take longer to craft.

 Write one or two questions after each class, so that it becomes a simple to assemble them into an
exam.

Designing Stems

 Phrase stems as clearly as possible

 Confusing questions can generate wrong answers from students.

 Express the full problem in the stem.

 Put all relevant material in the stem.

 Eliminate excessive wording and irrelevant information from the stem as they add to the students'
reading time. For example, "According to Freud model, groups develop through several stages
over time. Furthermore, it contradicts Poole's activity-track model which has groups switching
among several different linear sequences. Which of the following is not one of the stages
identified in Tuckman's model? The best way to write this question is "Tuckman's model of group
development includes: [Select all that apply]"

 Include any language in the stem that you would have to repeat in each answer option. E.g. a stem
such as "Biology is defined as the scientific study of:" keeps you from having to repeat "is the
scientific study of" at the beginning of each option.

Designing answer options

Avoid lifting phrases directly from text or lecture. This becomes a simple recall activity for the
student.

Write the correct answer before writing the distracters. This makes sure you pay enough attention to
formulating the one clearly correct answer.

Answer options should be about the same length and parallel in grammatical structure. Too much
detail or different grammatical structure can give the answer away.

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E.g. the term "side effect" of a drug:

a) Refers to any action of a drug in the body other than the one the doctor wanted to drug to have.

b) Is the chain effect of a drug

c) Additionally benefits the drug.

Limit the number of answer options. Three-choice items are about as effective as four-choice items.
Four choice items are the most popular, and never give more than five alternatives.

Distracters must be incorrect, but plausible. If you can, include among the distracters options that
contain common errors. Students will be motivated to listen to your explanations of why those options
are incorrect. To make distracters more plausible, use words that should be familiar to students. If a
recognizable key word appears in the correct answer, it should appear in some or all of the distracters
as well.

 E.g. Every organism is made of cells and every cell comes from another cell. This is the:

o a) Relativity Theory

o b) Evolution Theory

o c) Heat Theory

o d) Cell Theory

Use rarely extreme words like "all," "always" and "never" (generally a wrong answer). Vague words
or phrases like "usually," "typically" and "may be" (generally a correct answer). "All of the above" -
eliminating one distracter immediately eliminates this, too.

"None of the above" - use only when the correct answer can be absolutely correct, such as in math,
grammar, historical dates, geography, etc.

 Do not use with negatively-stated stems, as the resulting double-negative is confusing.

 Instruct students to select the best answer rather than the correct answer.

 Use familiar language.

 Avoid giving verbal association clues from the stem in the key.

 Randomly distribute the correct response.

 Avoid overlapping choices.

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True-False Item
A true-false item can be written in one of three forms: simple, complex, or compound. Answers can
consist of only two choices (simple), more than two choices (complex), or two choices plus a
conditional completion response (compound). An example of each type of true-false item follows:

 SIMPLE: The acquisition of morality is a developmental process. T or F

 COMPLEX: The acquisition of morality is a developmental process. T or F or Opinion

 COMPOUND: The acquisition of morality is a developmental process. T or F; what makes this

statement false or true?

Advantages of Using True-False Items

True-False items can provide:

 The widest sampling of content or objectives per unit of testing time.

 Scoring efficiency and accuracy.

 Versatility in measuring all levels of cognitive ability.

 Highly reliable test scores.

 An objective measurement of student achievement or ability.

Limitations in Using True-False Items

 Do not discriminate between students of varying ability as well as other item types

 Can often include more irrelevant clues than do other item types.

 Can often lead an instructor to favor testing of trivial knowledge.

 Hold extremely high guessing factor. For simple true-false items, each student has a 50/50 chance
of correctly answering the item without any knowledge of the item's content

 Difficult to write statements that are unequivocally true or false thus end up writing ambiguous
statements.

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Short Answer Questions

The short answer questions must be reserved for situations when supplying the answer is a necessary
part of the learning outcome to be measured, such as: when the intent is to have students recall the
information (instead of recognizing it), where computational problems are used, where a multiple-
choice, true-false, or check all that apply would make the answer obvious.

Strengths

 Provides a wide sampling of content.

 Efficiently measures lower levels of cognitive ability.

 Minimizes guessing as compared to multiple-choice or true-false questions.

 Takes less time to complete than multiple-choice questions, so can cover more content area.

Limitations

 Difficult to phrase the question or incomplete statement so that only one answer is correct.

 Misspelling can be a problem, particularly when computer scored, making test scores a
mixture of content learning and spelling skill.

 Difficult to measure learning objectives requiring more than simple recall of information.

 Often include more irrelevant clues than do other question types.

 More time consuming to score than multiple-choice or true-false questions.

 More difficult to score since multiple answers may have to be considered if the question was
not properly written.

Essay Questions

This is a test item which requires a response composed by the examinee, usually in the form of one or
more sentences. A single response or pattern of responses can be listed as correct. Accuracy and
quality of the answer can be judged subjectively only by one skilled or informed in the subject.

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Activity 7.2
Write down the strengths and weaknesses of Essay questions.
Compare your answers to those given at the end of the unit.

Writing Good Essay Questions

 Clearly define the intended learning outcome to be assessed by the item.

 Avoid using essay questions for intended learning outcomes that are better assessed with other
kinds of assessment. For example, if you want to assess physical examination, do not use essay
questions, rather use a practical tool such as an OSCE.

 Present a reasonable task to students.

 Use several relatively short essay questions rather than one long one.

 Improve the essay question through preview and review.

 Write a model answer.

Developing Marking Keys for Essay Questions.

Marking an essay is subjective. You should design some aspects that may influence the reader of an
essay and use as guideline. When marking essays you can use the following guide.

Content

 Topic and the ideas used to construct its content are most important.

 Evidence of probing the primary (original paper) and secondary literature (review chapters).

 Depth of analysis of the subject.

 Integration of ideas (presenting bits of information in a chronological manner, results of one paper
followed by another, showing signs of integrating thematic material from several sources

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 Depth of analysis of the subject (paraphrasing the material or critically analyzing the material,
citation of the literature)

Organization

 Appropriate title.

 A thoughtful Introduction.

 Discussion with Logical ordering of ideas.

 Smooth and logical transitions between ideas.

 A thoughtful conclusion.

Accuracy/style and Grammar

 Defines jargon, acronyms, use of abbreviations correctly.

 Correct grammar and spelling.

Overall Impression

 Impressive professional presentation.

 Neatness

 Other bonus marks

7.8 Validity and Reliability in Assessment

A good assessment has both validity and reliability attributes. Ensuring validity and reliability in
assessment starts from developing the specifications, producing the question papers or tasks and their
associated mark keys to the marking and awarding processes. The purpose is to ensure that the results
awarded provide a true measure of the knowledge, attitudes and skills that the assessment in question
is intended to measure.

Validity

This is the extent to which an assessment interpretation matches what it sets out to measure. Validity
entails the extent to which the inferences made from a test (i.e., that the student knows the material of
interest or not) is justified and accurate.

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Examples of validity:

Face validity- the measure of the extent to which an examination looks like an examination in the
subject concerned.

Content validity- measure of how closely the content of an assessment matches the content of the
specification it is designed to assess.

Construct validity- Construct validity measures the extent to which an examination actually measures
what the specification says it is intended to measure.

Reliability

This is the extent to which the result is likely to be same if the same individuals were assessed by
other people or the assessment was repeated at another time. Examples are:

Split half reliability- where you randomly divide all items that purport to measure the same construct
into two sets.

Test-retest- used to assess the consistency of a measure from one time to another.

Inter-rater reliability- Inter -rater reliability refers to the concern that a student's score may vary from
rater to rater.

When discussing reliability issues, there are several measurement errors which can be caused by one
of three factors:

 Examinee-specific factors such as motivation, concentration, fatigue, boredom, momentary

lapses of memory, carelessness in marking answers, and luck in guessing

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 Test-specific factors such as the specific set of questions selected for a test, ambiguous or tricky
items, and poor direction

 Scoring-specific factors such as non-uniform scoring guidelines, carelessness, and counting or

computational errors.

Both Valid and Reliable Instrument

Ensuring Validity and Reliability

Some of the ways in which we can ensure validity and reliability of the test scores are:

 Deciding on a test‘s objectives.

 Using different examination techniques.

 Careful construction of examination questions.

 Pilot the test among students or colleagues.

 Developing marking keys.

 Constructing an examination blueprint.

 Examination Blueprint

What is an Examination Blueprint?

This is an organizational framework into which a consideration of educational domains, test methods,
competence areas and content areas are considered to enhance validity and reliability of examinations.
Examination blueprint identifies the achievement domains being measured. It ensures a fair and

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representative sample of questions in the examination. It also allows the teacher to construct an
examination which focuses on key areas and weighting.

Basic features

 Exam is comprehensive

 It reduces teacher‘s bias towards petty questions.

 The exam has wider coverage of knowledge and skills.

 It has psychometric advantages- enhances reliability and validity.

 A clear understanding of domains, competence areas, content to be assessed and how.

 Precise and clear considerations of psychometric issues.

 A weighting guide.

 Must be done in advance.

 Must be done by the team responsible for examinations.

 Can be done in a 2x2 matrix.

Weigh the appropriateness of the distribution of checks against students‘ level, importance of test and
amount of time available.

Sample of Examination Blue Print

Competence CVS RS Neuro GI GU/ MSS Endo/ Haem/ Other

categories Renal Metab Oncology

History taking Chest Raised

Pain Blood
Sugar
Physical Exam Shortness Weight
of breath Loss

Tests and headache Visual

Procedures loss

Data Interpretation Jaundice

Management Acute
Retention

Communication Joint
and patients Pain
Education

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Weighting the Exam

More important competencies are accorded more weight. The number of questions for
important competencies is increased. You should always Design questions around the
problems in the blueprint.

Unit Summary

Summary
 In this unit, we discussed measurement and evaluation. We
looked at principles and purposes including different techniques
used in assessment.
 When planning for an assessment you must first, plan what
content is to be used in the exam. You should also choose the
best method to measure specific outcomes. Keep in mind class
size.

 In creating essay exams, make sure ample time is allotted for

completion of exam.

 Congratulations for completing unit 7 successfully! This

means that you are now ready to advance to unit 8 which focuses
on micro teaching and lesson planning.

POSSIBLE ANSWERS TO ACTIVITY 7.1

Strengths of MCQs

 They test a wide range of issues in a short time.

 Assessment is not affected by a student's ability to write.

 They can be reliably marked as all answers are predetermined.

 A large bank of questions can be built up to reduce future

preparation time.

 They can be used for quick revision at the start or end of a class
and marked by the students.

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Weaknesses of MCQs

 Do not test the student's ability to develop and organise ideas and
present these in a coherent argument.

 It takes a long time to write plausible distractors - especially in

cases where higher order cognitive skills are being tested.

 Guessing may result.

 Questions need to be pre-tested and items reviewed to ensure the

validity of the items.

 Restrictions are placed on the student‘s answers as they must

select from your alternatives.

POSSIBLE ANSWERS TO ACTIVITY 7.2

Strengths of Essay Questions

 Assess higher-order or critical thinking skills.

 Evaluates student thinking and reasoning.

 Provides authentic experience.

 Easy to construct (Good essay questions are not easy to

construct).

Weaknesses of Essay Questions

 Assess a limited sample of the range of content.

 Difficult and time-consuming to grade.

 Disadvantageous to students with poor writing skills.

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Unit 8: Micro Teaching and Lesson Planning

Introduction
In unit, we will discuss various principles and concepts that relate to the art of teaching. We
will briefly discuss the concept of micro teaching which you will be required to conduct
before you go for teaching practice. We will also discuss lesson planning and different
teaching techniques.

Aim
The unit aims at equipping you with knowledge and skills in lesson planning and teaching
techniques in order to prepare you for the role of teaching.

Objectives

At the end of the unit, you should be able to:

1. State purposes of microteaching.
2. Outline the principles of micro-teaching
3. Describe the characteristics of microteaching
4. Prepare a lesson plan

Time Required
To study this unit, you require 4 hours

Teaching skills are learned through a lot of practices. Scaling down teaching in a controlled
environment is beneficial to identify deficiencies of student teachers.

8.1 Definition
This is a teacher education technique which allows teachers to apply clearly defined teaching skills to
carefully prepared lesson plans in a planned series of 5 to 10 minutes with a small group of students
(Melish, Brink and Paton, 2008). The teacher is put under a microscope so that all faults in the
teaching methodology are brought into perspective. It helps the teacher trainee to master the teaching
skills.

It requires the teacher trainee:

 To teach a single concept of content

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 Using a specified teaching skill

 For a short time

 To a very small member of pupils

Purposes
 Enable teacher trainees to learn and assimilate new teaching skills under controlled
conditions.
 Gain confidence in teaching.
 Improve teacher‘s teaching skills
 Improve skill of public speaking
 Review a topic
 Update knowledge
 Master a topic
 Teach time management, educational media management.

Characteristic of Microteaching
 Micro teaching is a highly individualized training device
 It is an experiment in the field of teacher education which has been incorporated in the
practice teaching schedule
 It is a student teaching skill training technique and not a teaching technique or method
 Microteaching is micro in the sense that it scales down the complexities of real teaching
 Reducing the class size to 5 – 10 pupil
 Reducing the duration of lesson to 5 – 10 minutes
 Limiting the content to a single concept
 Immediate feedback helps in improving, fixing and motivating learning
 The students are providing immediate feedback in terms of peer group feedback,
tape/video recorded
 Microteaching advocates the choice and practice of one skill at a time

Principles of Microteaching
 Psychological theory of reinforcement
 Pedagogical principle of practice and drill
 Principle of evaluation by supervisor and self evaluation
 Microscopic supervision
 Continuity

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8.2 Teaching Skills

Component Skills Approach
 Lesson Planning.
o Clear cut objectives.
o Appropriate planned sequence.
 Set induction.
o Process of gaining pupil attention at the beginning of the class.
 Presentation
o Explaining, narrating, giving appropriate illustrations and examples
o Planned repetition where necessary.
 Stimulus variation
o Avoidance of boredom amongst students by gestures, movements, focusing,
silence, changing sensory channels etc.
 Proper use of Audio visual aids
 Reinforcement
o Recognizing pupil difficulties, listening, encouraging pupil participation and
response.
 Questioning
o Fluency in asking questions, passing questions and adapting questions.
 Silence and non verbal cues
o Body language
 Closure
o Method of concluding a teaching session so as to bring out the relevance of what
has been learnt
o Connection with the past learning
o Application to future learning.

Core Teaching Skills and their Components

Probing Questions
 Components :
◦ Prompting
◦ Seeking further information
◦ Redirection
◦ Focusing

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Explaining
 Components :
◦ Clarity
◦ Continuity
◦ Relevance to content using beginning and concluding statements, covering
essential points.
Illustrating with examples
 Components :
◦ Simple
◦ Relevant and interesting examples
◦ Appropriate media
Stimulus variation
 Components :
◦ Body movements,
◦ gestures,
◦ change in speech pattern,
◦ change in interaction style,
◦ pausing,
◦ focusing,
◦ oral-visual switching.

Reinforcement
 Components :
◦ Use of praise words and statements,
◦ accepting and using pupils‘ idea,
◦ repeating and rephrasing,
◦ Use of pleasant and approving gestures and expressions, writing pupils‘ answer
on the black board.

Use of blackboard
Components : Legible, neat and adequate with reference to content covered.

8.3 Preparation of Lesson Plan

A lesson plan is a teacher‘s detailed description of the course of instruction for an individual
lesson.

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Setting an objective

The first thing a teacher must do is to decide on the lesson plan's focus. The teacher should
create one idea or question they want the students to explore or answer. Next, the teacher
creates classroom activities that correlate with the established idea or question. This includes
individual and group activities. Identify what skills the lesson plan must cover. You must also
ensure the lesson plan adheres to the best practices used in teaching. Conduct research on
what teaching methods result in a high success rate for students. Ensure the lesson plan goals
are compatible with the developmental level of the students.

Selecting lesson plan material

A lesson plan must correlate with the text book the class uses. The teacher must take great
care and select the most appropriate book for the students

Unit structure – whether this will involve the whole-class where the teacher lectures to the
class as a whole and has the class collectively participate in classroom discussions or small
groups in which the students work on assignments in groups of three or four. This can also be
workshops where students perform various tasks simultaneously. Workshop activities must be
tailored to the lesson plan. Other activities may include independent work in which students
complete assignments individually or peer learning where students work together, face to
face, so they can learn from one another.

Format of Lesson Plan

 Course Title
 Topic of the lesson
 Target group: Class and size
 Date
 Time required to complete the lesson
 Venue
 Teaching Method
 List of required materials/AVAs.
 List of behavioural objectives.
o General

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o Specific
 Content
 An instructional component
o Teacher‘s activity
o Student activity
 Evaluation
o a test for mastery of the instructed skills or concepts such as a set of questions to answer
or a instructions to follow
 Summary
o where the teacher wraps up the discussion and answers questions
 Assignment
 References

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LESSON PLAN

COURSE TITLE: MSN 510 STUDENT: M. Makukula

TOPIC OF THE LESSON: Sickle Cell Disease

TARGET GROUP: 5th Year BSc Nursing

CLASS SIZE: 10

DATE: 31st July 2013

TIME REQUIRED: 30 minutes

VENUE: DNS Classroom 3

TEACHING METHOD: Lecture and discussion

AUDIOVISUAL AIDS: Laptop, LCD, Flip Chart, markers, Chalk board, chalk.

General Objective: At the end of the lecture/discussion, the students should be able to gain knowledge and skills to nurse a child with sickle cell
anaemia.

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Specific Objectives:

At the end of the lecture/discussion, students should be able to:

1. Define sickle cell disease.

2. Classify sickle cell disease.
3. Describe the pathophysiology of sickle cell anaemia.
4. State the signs and symptoms of sickle cell anaemia.
5. Describe the management of a child with sickle cell anaemia.
6. Outline factors that precipitate a sickle cell crisis.
7. State the clinical presentation of sickle cell crisis.
8. Discuss strategies for prevention of sickle cell crisis.

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Time Specific Content AVA Teacher’s Student’s Evaluation

Objective activity activity

2 Introduction Explaining, Listening,

minutes asking answering
Sickle cell disease is found mostly in people of
questions. questions.
African or West Indian origin. Each year about
156,000 infants are born with sickle cell disease,
of which 130, 000 are born in Africa. In this
condition defective genes produce abnormal
hemoglobin beta chains; the resulting Hb is called
Hbs.

In Sickle Cell Anemia, abnormal genes have been

inherited from both parents, where as in Sickle
Cell trait only one abnormal gene has been
inherited.

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2 Define Definition of Sickle Cell Disease Laptop, LCD, flip Explaining Listening, What is sickle
minutes Sickle Cell chart, markers, concepts, answering cell disease?
It is a condition resulting from the inheritance of
Disease chalk board, chalk. asking and questions,
two abnormal allelomorphic genes controlling β
answering taking notes.
globin formation.
questions,
showing
slides.

2 Classify Classification of Sickle Cell Disease Laptop, LCD, flip Explaining Listening, What are the
minutes sickle cell chart, markers, concepts, answering different types
Sickle Cell Trait (Heterozygous HbSs)
disease chalk board, chalk. asking and questions, of sickle cell
It is a condition arising from the inheritance of
answering taking notes. disease?
one normal β globin gene and one βs gene.
questions,
Sickle Cell Anemia (Homozygous Hbss) showing

Sickled cells have an increased fragility and slides.

shortened life span of 17 days, which results in

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chronic hemolytic anemia and causes episodes of

ischemia. It arises from inheritance of 1 abnormal
β globin gene from both parents.

Summary

What have you covered in the lecture/discussion?

Assignment

References

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Unit Summary

Summary
 Teaching is an art and as such student teachers must practice to
gain the skill. Micro teaching helps you to achieve this. In this
unit, you have studied micro teaching, its principles and most
importantly the various teaching techniques that are important.
 You have also learnt how to prepare a lesson plan. This will
help you in your future role as a teacher.
 Congratulations for completing unit 8 successfully! This
means that you are now ready to advance to unit 9 which focuses
on planning and managing educational programmes.

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Unit 9: Managing Nursing Educational

Programmes
Introduction
In unit 9, we are going to focus on planning and managing educational programmes,
specifically nurse education programmes. The unit covers processes that are involved in
managing educational programmes and these are policy, planning, budgeting, determining
work procedures and organisation.

Aim
The unit aims at equipping you with knowledge and skills in planning and managing nursing
education programmes.

Objectives

At the end of the unit, you should be able to:

1. Describe the various processes that are used in managing nursing education
programmes
2. Describe the budgeting process

Time Required
To study this unit, you require 6 hours

9.1 Planning and Organising Educational Programmes

Quality of teaching and learning in a nursing school depends on effective management and
administration. In nursing college administration activities are carried out when two or more
people work together. This is in order that nursing education may be provided. Produce
efficient nurse practitioners capable of managing their independent functions in a responsible
and humanitarian manner.

Processes of Managing Nursing Schools

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There are several processes that are used in managing Schools of nursing. However, in this module we
will only discuss five which are policy making, organization, determining work procedures, planning
and budgeting.

9.2 Policy Making

Policy making leads to planning and programming. Policy making in nursing education is done by the
General Nursing Council (GNC) which is the regulatory body, Authority in charge of providing
education, and the local School. The GNC sets policies in accordance with the Nurses and Midwives
Act No. 31 of 1997.

The authority in charge of the provision of nursing education for example the Ministry of Health,
Missionaries, Other institutions also formulates policies. These function within the powers. They are
responsible for policy making in terms of:

 Sitting of training schools.

 Decisions regarding types of training to be offered.
 Facilities and resources-human and material, to be supplied and budgeting.
 Training of teaching personnel
 Human resource development opportunities and programmes to be provided for personnel
 Recruitment of students for all schools.

The local school providing education

These pertain to block periods or other systems of nursing education, Time allocated for the blocks,
study days etc. Policies made by the local school include:
 Who teaches what, when and how
 Policy regarding team teaching, subject teaching, the whole syllabus for a block system of
teaching, use of outside lecturers and their availability.
 Compulsory study periods
 Use of notes instead of textbooks.
 Safekeeping of Audio visual aids
 Timetables, and who is responsible for compiling them.
 Availability of library facilities and other learning aids, hours, etc.
 Duration of lecture periods/formal teaching sessions
 System of record keeping, such as lecture records, class attendance
 Breaks during the day

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 Safekeeping of AVAs
 Timetables, and who is responsible for compiling them.
 Availability of library facilities and other learning aids, hours, etc.
 Duration of lecture periods/formal teaching sessions
 System of record keeping, such as lecture records, class attendance
 Breaks during the day
 Recreation facilities and encouragement to use them
 Projects, assignments, workbooks

9.3 Organisation
This is the most readily understood. Organization is done to provide those who are to carry out the
action planned under the policy making, with what is necessary to attain the stated objectives. All
those concerned with nursing education i.e. teaching staff, clinical staff etc should be involved in the
initial planning. Several consultations must be done. The Principal tutor is the coordinator of all
activities though team work, understanding of requirements and communication are vital.
Organization involves:

 Courses offered and their organization

 Numbers of students to be catered for.
 Regulations regarding courses
 Curriculum
 Teaching methodology
 Outside educational facilities for field work
 Facilities available
o Personnel, nursing (nurse educators) and clerical
o Classrooms and other study accommodation
o Office and teaching space and space for clerical work
o Library
o Other resources
 Liaison with university, community services
 Record keeping system including those required by registering authority.
 Evaluation procedures
 Timetables
 A chart showing lines of communication and the delegation of work and authority given to each
member of the teaching staff.
 House keeping issues

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9.4 Determining Work Procedures

This process is vital so that members of the team charged with policy implementation can work
together in an orderly constructive manner. However, it is difficult to apply in a nursing school. Work
procedures to be followed include:

 Compliance with the Nursing Council regulations

 Effective record keeping
 Methods of ordering, obtaining and safekeeping equipment and using stocks.
 Budgeting and remaining within the budget.
 Maintenance of buildings, grounds etc.
 Providing accommodation
 Supervision
 Methods of dealing with complaints.
 Planning must be in such a way that any work procedure such as the standardisation of a technical
procedure in the clinical area, can be worked out, made known and included in the teaching
programme.

9.5 Planning
It‘s a process of determining in advance specifically what should be done, when, how and by who, in
order to achieve particular organisational goals.

Principles of planning
 The plan must be flexible so that it can be modified and revised if need arises.

 The plans should be practical, economically feasible, and professionally sound.

 The aims and objectives of the institution must be clear, relevant, observable and measurable

 Involve subordinates in the planning process to ensure acceptance of the plan by those who are
going to implement them.

 Assign planning responsibilities to the right people.

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Types of Planning in the School

Strategic Planning (SP)

In SP, plans made for the whole organisation. Usually long term plans of 1 to 5 years or longer.
Examples of strategic planning in the School are action planning and school budget. The School
budget is independent from that of the hospital. School faculty participates in this activity and the
principle tutor chairs the budget planning meeting. Other SP are the School Master Plan. The master
plan is done by the faculty and spearheaded by the group tutor. It covers the whole 3 year period that
students are in training. It reflects period of training, block periods, clinical allocations, area of
specialties, examinations and vacation. The plan directs the faculty and helps them achieve their goals
in time as long as they stick to it.

Selection and Recruitment of students planning

School plans for the recruitment process and interviews. It is important to avoid overlaps in the
activities. Other SP are graduation ceremonies, Staff development and all these must be planned for
annually and reflects in the action plan.

Operational Planning
Daily or monthly working management plans developed from long term and as well as short
objectives. Some of the operational plans in the school of nursing are
 Time tables
o Normally the group tutor is responsible for the preparing of time tables for their
respective groups on a weekly basis.
o Clinical teachers prepare the prepare the clinical allocation time table for the students
 Meetings
o Planned and held according to the long term plan or as need arises.
 Examinations
 School supplies and maintenance of school property.

9.6 Budgeting and Costing for the School Activities

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Budgeting decisions affect everyone who works in any organisation. Nurse educators need to have a
working knowledge of the budgetary process. Budgeting helps them to anticipate changes and adapt to
decisions made based on the financial status of the institutions. Each school of nursing draws up its
own budget to meet its own needs. It should be policy that each nurse educator keeps a list during the
year of urgent requirements or replacement equipment. The principal then collects and collates this
information and use it in budgeting. It is the responsibility of all staff in the school to use materials
and equipment effectively but economically.

Importance of Budgeting

It has an effect on people‘s work. Budgeting helps you to take care of salaries and other incentives and
plan for the number of people available to do the work. Budgeting also helps you to know the quality
and quantity of equipment and supplies available.

Planning in budgeting is very critical. As an educator you should plan for the management of
monetary resources. To create a budget you predict how much money the institution will
generate in the next fiscal year and how much it will spend in order to continue running. Look
ahead as well the past costs and income. Consider trends such as economic inflation or
recession, community needs, public demands, anticipated heath care reforms, changes in
health care methodologies and competition from other institutions.

Principles of resource allocation are that resources are always scarce to some degree in
relation to needs and wants of those to whom they will be distributed. Alternative ways to
allocate resources can always be found- no right way guides the design of a budget.

Types of Budgeting

Incremental Budgeting/historical

This is the traditional process in which budgets are prepared every year on the basis of what
was spent the year before (Berman & Weeks, 1979). Components of the budget are income
by its source (Govt grant, Donations etc) and expenses (salaries, benefits, equipment,
supplies staff education etc).

Zero-Based Budgeting

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This type of budgeting requires more justification from each unit for any funds budgeted for
the next year. Use of the decision package is the core of ZBB. It consists of several basic
elements:

 A listing of all current and proposed objectives or activities of the school/team

 Alternative ways of carrying out these activities and different costs for each alternative.

 Advantages of continuing the activity

 Consequences of discontinuing the activity.

Budgeting Process

Phase I: Planning

This takes place during the course of the year. It is the most important part of the financial
management. You need to set short and long term goals. Obtain input from staff, prioritize
objectives, analyse past performance, predict future costs and revenues, review time lines for
budget completion, ascertain estimates, compare costs and identify capital equipment needs.

Phase II: Drafting

In this phase, you translate objectives into projected costs and revenues. Write justifications
for all requested expenses and present proposed budget. Also submit capital requests. The
completed budget usually includes a breakdown of monthly costs and revenues as well as the
totals for the year.

Phase III: Modification and Approval

At this stage, you receive back the preliminary budget from management review. You may be
required to eliminate lowest priority items if necessary. The budget will then be approved.
The final approved budget will then be communicated.

Phase IV: Monitoring

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You must review monthly summaries of expenses and revenues. Compare actual expenses
with budgeted expenses to determine variances. Investigate and provide justification for any
variance within your budget guidelines. Readjust budget and/or improve performance as
necessary. It is important that you continue to monitor on monthly basis.

Unit Summary

Summary
 The covered the different processes that are involved when
managing nursing education programmes. These include policy
making which is done at GNC level, authority in charge of the
School and the local school; organization, determining work
procedures, planning and budgeting.
 We also discussed the budgeting process in detail.
 Now look back and see if all the objectives outlined have been
achieved.
 Congratulations for completing unit 9 successfully! This
means that you are now ready to advance to unit 10 which
focuses on providing student support and guidance.

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Unit 10: Student Support and Guidance

Introduction to Medicine and Medical Nursing

Introduction
This unit covers concepts that relate to student support and guidance. As you know, one of the roles of
the teacher is to help students who are experiencing different problems that may affect their academic
performance. It is therefore important for you to understand the different concepts that relate to
offering student support and guidance

Aim
The unit aims at equipping you with knowledge and skills in concepts of students support and
guidance in order to support your students.

Objectives
Upon completion of this unit you will be able to:
1. Describe the different concepts in support and guidance
2. Outline problems that student face in an academic environment
3. Offer support and guidance to students facing different problems

Objectives

Time Required
To study this unit, you require 2 hours

Student support and guidance means to direct or lead. Guidance involves help given by one person to
another in making choices and adjustments and solving problems. It aims at aiding the recipient to
grow in his independence, and ability to be responsible for himself.

Counselling on the other hand is a specialised service of guidance. It is an enabling process designed
to help an individual grow to greater maturity through learning to take responsibility and make
decisions for himself/herself.

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10.1 Scope of Guidance and Counselling

Guidance and counselling aim at assisting students to draw up their own plans of academic and non
academic pursuits. They are intended to help individuals to realise his potential. The two concepts are
used to help the person to solve his/her own problems and make proper choice and adjustment. They
aim at providing assistance to teachers in their efforts to understand their students.

Principles of Counselling and Guidance

 Unique to an individual

 Concerned with the total individual.

 Always goal oriented and goal directed.

 Meant for all those who need help.

 Continuous process

 Based on reliable data

 Flexible.

Phases of Counselling

 Exploration

o Establish a warm trusting non threatening relationship.

o Active listening

 Assessment

 Setting goals

 Action

 Termination and follow-up.

o Guidance

 Encouraging and supporting

 Informing and advising

 Liaising and representing

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 Monitoring and coaching

o Areas of support and Guidance

 Identify problems before they occur.

o Academic

o Social

o Emotional/psychological

Reasons why students experience academic problems

 Lack of motivation

 Difficulties in adapting to college life

 Inadequate time management

 Study skills challenges

 Social distractions

 Learning disabilities

 Substance abuse

 Psychological issues

Identification of student‘s problem

 How do we identify student‘s problems?

 Students‘ records on e.g. Assessments tests

 Observations

 Interviews with other teaching staff and peers

10.2 Support and Guidance

 Offer an orientation program where students can learn study skills

 Learn about their learning style and personality and about the available resources on campus.

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 Match services available to online students with those available to on-campus students as best as
possible.

 Maintain a clean and welcoming teaching learning environment for on-campus students and a
well-structured, well-organized and functional online learning environment.

 Don‘t wait for students to complaint about something

 Higher education leaders must be intentional in seeking out students to see how they are doing
and how they can be aided in advancing their studies and preparedness for the workforce.

 Respond to students‘ complaints and challenges timely and equitably.

 Cross-curricular teaching and learning and engaged scholarship opportunities for students, staff
and faculty members.

 Grade students‘ papers early and provide timely and constructive feedback that support students‘
development.

 Culturally sensitive teaching and learning environment where diversity is used as a point of
teaching sensitivity to differences.

 Strong academic advisory center and personnel.

 Electronic databases along with a library for books on careers, financial aid and programs and
information.

 Financial resources based on need and merit-based support.

 Health services and life skills services

 Encourage the formation of student arm of professional associations on campus where students
can learn about their chosen profession and get involved on the student level.

 Opportunities for students to learn from faculty through mentoring, coaching and other types of
collaborative learning opportunities.

 When counseling include:

o Academic

o Study skills

o Time management

o Using the library and other resources

o Examination techniques

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o Social issues

Unit Summary

Summary
 In this unit, you have some concepts that relate to student support
and guidance. It is important for every teacher to be equipped
with knowledge and skills in counselling and guidance so that
you identify problems before they occur and deal with them.
 Congratulations for completing unit 10 successfully! This
means that you are now ready to do your TEACHING
PRACTICE!

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