Teaching and assessing on course for change Peter French and Dennis Cross

This paper argues that the concept of change is a valuable tool for the development of continuing education which is relevant to the personal needs of nurse practitioners and to clinical practice. The context for this discussion is a teaching and assessing course which holds the concept of change as the central philosophy for curriculum structure. The paper begins by describing the course philosophy, curriculum models and outline structure which typify this course. The second part of the paper describes research used to evaluate the 13 courses which have been held and the main conclusions of this research. It is concluded that this course has proven educational benefits and effects on clinical practice which include the development of critical reflectivity, acceptance of change, increase in self confidence and an increase in self-directed learning.

an appropriate

INTRODUCTION During 1987 the South Tees District School of Nursing

Continuing

undertook ‘I‘eaching English

to

plan

Education for

and Assessing National

the

Department

provision

course validated

Board.

convey the key philosophies evaluation

of

a

by the

It is our intention

to

of this course and an

of the course based on our experience

of the 13 courses which have been completed

by

I he time this paper was written.

the outline

which arose, when identifying

Peter French, PhD BA(Hons) RGN RMN RMN Principal Lecturer in Nursing Studies, Hon Staff Nurse, South Tees Health District, Department of Health and Community Studies, Teesside Polytechnic, Middlesbrough, Cleveland Dennis Cross, MA BEd(Hons) RGN RMN, Senior Lecturer in Nursing Studies, Teesside Polytechnic, Hon CPN, South West Durham Health District (Requests for offprints to PF) Manuscript accepted 19 July 1990

was related

of the course.

syllabus

for

to the

A scrutiny

the ENB

998

of’

course

confirmed

that the course was to be targeted

Registered

Nurses who were actively involved in

clinical practice.

We decided

at

that the purpose of

the course was to enable ward sisters and senior staff nurses to adequately support nurse learners in their own clinical environment and this was confirmed

by the outline

curriculum

pro-

vided by the ENB. This decision was also supported by the work of researchers in nurse education

THE CORE PHILOSOPHY ‘l‘he first question

philosophy,

aims and purposes

(Ogier.

1982: Marson,

1982;

Orton,

1979;

Fretwell,

1981). This work encouraged

us

to adopt the idea that the role of the nurse, in this setting, was to create a suitable learning

environ-

ment rather than to ‘teach’ per se. By adopting this proposition, and taking account of the suggested course content in the outline curriculum, it was decided

that the unifying

theme for

the course would be the concept of ‘change’. The following premises were the basis of the course philosophy: 1. Learning

is a change

concept.

20

NURSE EDUCATION

2. The

qualified

her/his others

TODAY

practitioners

own

learning

must manage

in order

to

to learn.

3. Helping

student

nurses to learn is synony-

mous with helping them to change. 4. The process of course development be seen as a process of continual 5. The

help

context

influenced

of

the

by professional,

is

organisational

and societal change.

in change,

it was assumed

active participants during

rather

When designing ourselves The

to participate

that they should experiences.

the course

it was anticipated

to bring

about

as well as in the course

following

be

than passive observers

their own learning

that we would need

were the crucial

change

in

participants. factors

in this

change:

to ‘participative’ 2. Change which

in

the

existed

strategies

from didactic

authority between

relationships teachers

and

3. Changes

in the teacher’s

knowledge

values

and skills. These

changes

designers,

would

course

affect

facilitator

sons as well as the course premises

were

Knowles

and resource by the (1975)

(1972) and the reader is encouraged such work for a greater rationale student

behind

course

participants.

substantiated

et al (1968),

the

work

to follow up

understanding between

were seen to be of primary

b)

4

case

was defined

in

detected point

that teachers

learning.

Another

tells tutor learning

of a

should

lecture

this is immediately

teacher

to encourage

in their students.

who

self-directed

The mode of learning about learning

and

noticeable.

In much the same way speaking

about diction

uses the mode which is the same as

the content which is being conveyed. that

an

elocutionist

people

to ‘speak proper’

student

teachers

In the same

cannot

encourage

the tutor

can not tell

to adopt participative

learning

This point has been laboured

it is central

to the philosophy

was adopted

for this course.

were adopted

because

of change

In order to achieve the required models

A

which

use experiential

is the didactic

students

dissonance

by the learner.

is the

does not fit the proposition

to guide

change,

which three

the curriculum

design. They were:

4

The

concept

of spiral

guide the curriculum

b)

The

experiential

and Bell

of the

(1975)

curriculum

-

to

structure.

taxonomy

of Steinaker

- to guide

the teaching

methodology. teacher

and

importance speci-

cl

A cyclic teaching knowledge

problem-solving process

model

of

- to guide the forms

the of

which were selected. (Adapted

from Kilty, 1982).

as:

A facilitator of learning A senior student

b) A role model c) 2. The student was defined a)

of

is an example

must match otherwise

advocates

and Sieber

in achieving change, and the following fications were outlined:

a)

common

these assumptions.

relationships

1. The teacher

perThese

of learning

are one and the same.

teaching

will be immediately

methods.

learners.

The

about

by

situation in which the disjunction between the mode of teaching and the propositions held

way

methods.

acquired

are very few learning

where the actual content

or language

1. Change in teaching

Fisher

to the attitudes

and the mode of learning

rel-

were seen to

There

about teaching

In order to enable course members

the unique

have in relationship

Teaching

process

to emphasise

course participants. situations

must

change.

learning

It is important

evance which these role definitions

as:

An equal and active participant/contributor in learning An enquirer A tester

THE COURSE DESIGN The course philosophy and selected curriculum models determined that the process of learning, rather than the outcome of learning was most important. Given that the course would be awarded

a statement

of attendance,

summative

NURSE EDUCATION

assessment describe each

was not necessary

and it was easy to

the course in process terms. The aims of

course

planning,

unit

emphasised

implementation

learning climates. with learning

the

and

assessment,

evaluation

of

methods

would be used on the course (Briefing

in nature

planning

completed

units. Students

which

Day) and

and the identification

then returned

presented

and

to clinical practice

returning

on the review day

their report on the attempted

in the learning

:, 1

by the end of the study

for 10 weeks before to present

The first units were concerned

about the teaching

formative

TODAY

climate

change

on the course.

to students

This was

on unit 6 of the course

an analysis of self (unit 1). The aims for each unit

which followed, enabling

were:

ing course to pick up ideas for their own change

linit aim

course

projects

BriefingTo

help the course participants

prepare

and look forward to the course units. Day Unit 1 To enable course participants to explore

and to make judgements

decisions LJnit 2

To

on themselves

enable

explore,

course

judge

make

about their own learning Unit 3

To

enable

develop

the course

Unit 4

To

enable

prepare

the

to

environment. participants

skills in methods change

course

of enquiry current

To

enable

the

participants learning

practice

course

project Keview dav

to current

and

to

activities

participants

to

change

issues in nursing

education

using

course

work. to stimulate

projects

cational

the oppor-

methods of

learning

obtained

Four

methods

first three progress

to participants

days to record

cation of responses Finally longer

their

The

were analysed

working

six

2-3-day

study units held weekly in blocks. These were to be completed in 5 weeks, each unit being separated

from the other by clinical practice and

days off. One of the processes which course members were to be involved in was the identification, planning and implementation of a smallscale change in ward organisation relevant to learning in that setting. The project would be

interviewees sampling course.

on the briefing

and

were

in the partici-

Twenty

interviews

classifi-

were evaluated with four sisters

participants This

and five of

data collection

out on a small sample so selected

by

opportunity

6 months after they had completed

The interviews were audio-recorded sciptions

Statements

1977).

term outcomes course

Nomthe was

(Zurcher.

could only be carried of

second,

by Zurcher’s

colleagues.

First a

to measure

third, 1970)

changes

pant’s self-perception.

data the

1975), to obtain

data on the course progress; and Twenty Statements Test (Hartley,

change

consisted

1981)

(Delbecq,

were

of

participants.

outcomes;

technique

who had been

design

bv analysis

the course.

test (Mezoff,

test results

THE CHANGE PROJECT

during

on learning

inal Group

review

in edu-

self-report

were used to collect

sharing

to their attempted

outcomes

occurred

through

with regard activities.

1989)

from 35 course

colleagues

and

dissertation

(Cross,

were used to evaluate the achievement

course

personalised

descriptive

course

a key element

OF CHANGE

for a Master’s

development

mainly by in-depth

‘The

become

of the course and philosophv.

THE EVALUATION

administered

To allow course participants tunity

change

pre-then-post

make decisions and recommend with regard

These

of the realisation

material

in a clinical setting. IJnit 5

for

their skill in small

group presentation.

As a subject to

in nursing.

and facilitate

an opportunity

to develop

and

decisions

with a view to understanding and future

as well as giving members

of the follow-

and peers. participants

and

members

analysed

using

gested by Jack Mezirow’s ‘Perspective Transformation’,

the

and tran-

categories

sug-

10 categories of (Merirow. 198 1).

First a structural analysis of interviews Mezirow’s 10 categories was completed

into and

22

NURSE EDUCATION

TODAY

Table 1 Frequency of sisters’ responses into 10 stages of perspective transformation Stage No

Sister 1

1 2 3 4 5 6 7 ! 10 Totals

Total No of Responses

Rank order of Frequency

1 1 4 1 2 1 0 0 2

1 1 2 2 1 3 1 2

0 1 2 1 0 2 1 0 3

2 4 10 6 4 8 3 4 9

10 6 1 4 6 3 9 6 2

2 15

1 13

3 18

0 10

6 56

4

(Table 1). Mezirow (198 1) considers the following

Sister 4

0 1 2 2 1 2 1 2

cross-checked by independent frequency of response chart

perspective

Responses Sister 3

Sister 2

transformation

judges, then a was constructed

that the dynamics of appear

to include

levels.

had increased their

their ability to critically reflect on

role as a nurse

with an improved

nalised

responses of personally

role assumptions

alieniation

This structural

dilemma;

2. self-examination; 3. a critical assessment

inter-

and a sense of

from traditional

social expec-

tations; 4. relating one’s discontent to similar experiences of others or to public issues recognising

that one’s problem

and not exclusively

is shared

a private matter;

5. exploring options for new ways of acting; 6. building up self-confidence and competenance in new roles; 7. planning

a course of action;

8. acquiring knowledge and skills for implementing one’s plans; 9. provisional efforts to try new roles and to assess feedback; into society on the basis of 10. a re-integration conditions dictated by a new perspective (Mezirow,

1981).

The results of the analysis of the interview data were considered to be the most relevant to this paper. These results indicated that the major effects of the course appeared to be that students

The

inter-

ability to stand back from their

working environment

to makejudgements,

sions and implement 1. a disorientating

and teacher.

viewees suggested that the primary effect of the course was a rise in their consciousness coupled

analysis and quantification

indicated

increased

that

course

in confidence,

learners

not

sing practice

and

the course

their

The

working

information

participants

of

participants

only

but also in their attitudes

with colleagues.

deci-

action.

in helping

towards nurrelationships provided

in interview

by

was con-

firmed by interviews with their colleagues

and by

the other three tools which were used to gather self-evaluations course.

during

Opinions

gested

that

and at the end of the

recorded

student

at interview

nurses’

emotional

were now central to the planning of clinical experience

sugneeds

and provision

as a result of the course.

Furthermore, there were many references in interview data and in data provided by other tools which indicated vided

the initial

planning grammes.

their

that the course

impetus

for nurses

own

developmental

had proto begin pro-

Diplomas in Nursing, degree prodistance learning and counselling grammes, courses were specifically described. These references to further professional post-registration education suggested that following the 998 course nurses had begun to take responsibility for their own further development.

In conclusion, tinuing

education

it is argued

of change has numerous as well as positive

here

course-based

educational

consequences

that a con-

on a philosophy advantages

in the clinical

setting. This paper has tried to demonstrate utility of a model for change

the

and the advantages

which can be gained.

References Cheren M I 1978 Facilitating the transition from external direction of learning to greater self-direction on learning institutions: a case study in invidualised open system post-secondary education. University of Massachussets, EdD Thesis Cross D J 1989 A critique of self-report methods in post-registration nurse education (ENB 998). Newcastle upon Tyne Polytechnic, MA Dissertation Delbecq A et al 1975 Group techniques for programme planning: a guide to nominal group and delphi processes. Glenview Fisher J D, Wesselmann R, et al 1968 ‘Agricultural extension training: a course for extension training programme’. United States Agency for International Development, Nairobi, Kenya pp 7 1-77 Fretwell J E 1982 Ward Teaching and Learning. Royal (lollege of Nursing, London

Hartley W S 1970 Manual for the twenty statements problem. Obtained from Dr Wynona S Hartley. Department of Community Health. University ot Kansas Medical Schook, Kansas Kilty J 1982 Experiential learning. Human Potential Research Project, University of Surre\ Knowles M 1975 self-directed learning: a guide for teachers. Associated Press, New York Marson S N 1981 Ward teacher skills - an investigation into the behaviour characteristics of effec t ward teachers. Sheffield Polytechnic CNAA hlPhil Thesis Mezirow J A critical theory of adult learning and education. Adult Education 3 1, 1: S-2-l Mezoff B 1987 How to get accurate self-reports of training outcomes. Training and Development Journal, September Ogier M B 1982 The ideal sister. Roval (:r)llegc 01 Nursing. London Orton H D 1979 Ward learning climate and student nurse response. Sheffield Polytechnic MPhil Thesis Sieber S D 1972 Images of the practitioner dnd strategies for educational change. Sociolog) oi Education 45 362-385 Steinaker N, Bell M R 1975 A proposed taxonom\ of educational objectives: the experiential domain. Educational Technology, January I!1 Stufflebeam D 1969 Evaluation ‘is enlightenment for decision making. In: Beatty M’ Improving Educational Assessment and IIlventol-\ of Measurrs of Affective Behaviour. .4ssociation for 5upervrsion and Curric-ulum Development, Washingti)u DC: Zurcher L.JI- 1977 The Mutable Self: A wll-C:cmc ep tolSocial Change. Sage Publications, Lw~tltm

Teaching and assessing on course for change.

This paper argues that the concept of change is a valuable tool for the development of continuing education which is relevant to the personal needs of...
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