Journal of Advanced Nursing, 1979, 4, 161-168
The inability to transfer dassroom learning to oiinioai nursing praotioe: a learning problem and its remedial plan Julia Wong R.N. B.Sc. M.ScN. Assistant Professor in Nursing, Dalhousie University, Halifax, Canada Accepted for publication 27 September 1978 WONG J. (i^jg) fournal of Advanced Nursing 4, 161-168
The inability to transfer classroom learning to clinical nursing practice: a learning problem and its remedial plan The inability to transfer classroom knowledge to clinical nursing practice is a common learning problem encountered by many nursing students. Manifestations of this problem may involve both the academic performance and personal development of the students: inability to solve problems in nursing situations; inflexibility and rigidity in the exercise of nursing care; fragmentation of nursing care; and apathy towards clinical practice. Because of the seriousness of this learning problem, a plan must be formulated to rectify it. This plan is developed with major emphasis on the teaching process, the student and the curriculum. One of the important roles of a teacher is to help students understand many widely useful relationships, principles or generalizations. In order to enhance transfer, nursing students must be given ample opportunities to apply the learned principles in a variety of nursing situations. Learning is a self-active process; an ideal transfer demands the students' conscious realization that transfer is possible. Students need to be committed to the belief that particular facts in the classroom study are pertinent in other situations. To promote transfer, the curriculum must be designed in such a way so that it has transfer value in terms of the students' goals and purposes. Furthermore, proper sequence of curricular activities is crucial if transfer of classroom knowledge to clinical practice is to occur.
INTRODUCTION It is a matter of observation among educators in the nursing profession that students who have imbibed a great deal of instruction in classroom lectures are unable to relate their instructional knowledge to actual clinical performance. A number of books and articles have been written in relation to this problem, a few of which will be quoted in the course of this paper. In a book entitled Problem Solving to Improve Classroom Learning, Schumuck
et al. (1966) state the matter thus: 'A problem exists when there is a discrepancy 0309-2402/79/0300-0161 $02.00
© 1979 Blackwell Scientific Publications 161
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J. Wong
between the actual and the desired state of affairs.' When this discrepancy prevails in learning, it may be viewed as an indication of a learning problem. An example may illustrate the point. The actual state of learning for a grade eight student is his ability to spell, while the desired state is a mastery of the grade eight level of spelling. Obviously a discrepancy exists. This discrepancy is an indication of a learning problem which interferes with the student's achievement. Learning problems may assume different characteristics in accordance with the settings in which they occur. In general education, most learning problems are associated with some learning disabilities; for example, inability to spell or write or difficulty in reading. On the other hand, students of the professional disciplines may experience problems or difficulties related to learning which are unique to their fields of study. Bregg (1958) contends that one basic educational problem for every student and teacher in a service-oriented profession is the problem of integration of practice and knowledge. Wisser (1974) reports that fewer than half of the students who participated in her study indicated that the learning of broad principles has been a means of solving the problem of technical discrepancies existing in the clinical area. She charges that the nurse educators are responsible for the development of this problem. She suggests that teachers have put much emphasis on the teaching of concepts and principles in the classroom but fail to help students to synthesize their knowledge and relate this knowledge to clinical practice. Wisser's accusation is valid since the transfer of classroom knowledge to the clinical practice is frequently a problem experienced by many nursing students. Other learning problems such as lack of motivation, difficulties related to problem solving and attitude learning also exist in nursing education. However, this paper will examine only one learning problem which seems important to the nursing students: the inability to transfer classroom knowledge to the clinical practice. Examination and discussion of this problem will follow this order: the concept of transfer of learning, the nature and the characteristics of this problem and the formulation of a plan to deal with it. Ellis (1965) views the concept of transfer of learning as a phenomenon when the experience or performance on one task influences subsequent learning or performance. Travers (1965) maintains that all educational and training programmes are built upon the assumption that human beings have the ability to transfer what they have learned in one situation to another. In fact, schools have no reason for existence other than the ability that teachers have to instil knowledge and teach students to transfer it to events outside the school setting. Thus, students are taught the skill in the writing of English not for the purpose of writing better themes in school, but for the reason that they will be able to prepare effective communications in their daily life. TRANSFER OF L E A R N I N G Among the theories which have been put forward to explain the transfer of learning, the formal discipline theory, the identical elements proposed by
Transferring classroom learning to clinical nursing practice Thorndike and the theory of generalization advanced by Judd are but three (Travers 1965). The formal discipline theory subscribes to the belief that human minds must go through the same kind of vigorous exercise as the muscles of an athlete for their strength. The formal discipline theorists believe that the teaching of difficult subjects will strengthen the faculties of the mind, such as memory, imagination, judgement and reason. Brubacher (1947) assumes that '. . . increase in power from the exercise of a faculty in one field of endeavour was thought to "transfer" automatically or at will to endeavours in other fields. . .' Because of his dissatisfaction with the formal discipline theorists' explanation of transfer, Thorndike proposes the theory of identical elements to account for any transfer that seems to exist. Within Thorndike's system learning is seen as the formation of honds between stimuli and responses. To Thorndike, transfer of learning will occur from one activity involving certain honds to another activity which also involves the same bonds. Judd proposes a somewhat different theory to explain the phenomenon of transfer of learning. According to Judd, transfer depends upon an individual's xmderstanding of the principles or generalizations which are inherent in any learning task. Abstractions, generalizations and applications are vital to his theory. In order to improve transfer, Judd proposes that the student must understand the fundamental principles of a subject; he must recognize the possibilities of applying these principles; he must be provided with the opportunity to employ the generalizations of one problem or suhject to another area.
Problems Difficulties and problems related to the transfer of learned principles to the clinical practice are learning problems encountered hy many nursing students. Wisser (1974) identifies the shift from the technical aspects of the nurse's education to the teaching of principles without the emphasizing of integration as a problem in nursing education today. As a result of this shift, nursing students may hecome superh passers of examinations, hut may be unable to help a troubled patient take heart. Bregg (1958) insists that students of service-oriented professions must he ahle to do more than simply ahsorh content and pass examinations. They must he able to transfer and to relate the learned principles to the nursing practice. Manifestations of the learning prohlem of inahility to transfer classroom knowledge to the clinical practice may involve hoth the academic performance and the personal development of the students. This problem may be recognized hy the students' failure to progress academically or the students' lack of interest in the involvement of the learning process. In general, this learning prohlem may be manifested in the following ways: 1 2 3 4
Inahility to solve prohlems in nursing situations. Inflexibility and rigidity in the exercise of the nursing care. Fragmentation of nursing care. Apathy towards clinical practice.
163
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People tend to view problem solvitig as different from transfer of learning. In actuality, problem solving is an example of positive transfer, since problem solving involves the referring of lov^^er order principles to higher order principles (De Cecco & Crawford 1974). Students who experience a great deal of difficulty in the transfer of learned principles to the clinical practice invariably encounter difficulty in problem solving. Hudgins (1966) reports that one of the characteristics of the poor problem solver is his unawareness of the fact that the knowledge he possesses can indeed be applied to the problem at hand. An example may crystallize this point. A beginning student nurse learns the principles related to meeting the patient's hygiene needs in the classroom. When she is assigned to attend to the needs of an elderly patient who is emaciated and unconscious, she fails to give good skin care to this patient. To be sure, the care of an unconscious patient is a new problem to this beginning student, but if she is able to transfer the knowledge she has learned about the meeting of the patient's hygiene needs, she can meet them adequately, irrespective of his medical diagnosis. Obviously, this student fails to become aware of the fact that the knowledge she possesses can indeed be applied to this novel clinical situation. However, upon probing by the teacher with some appropriate cues and suggestions, she may in fact recognize the information which could be appropriately transferred to the problem. But without the assistance of the teacher, it seems unlikely that the problem would have been solved.
££fects on the student Because of her inability to transfer learned principles and concepts to the clinical practice, the student becomes inflexible, rigid and frustrated in her clinical practice. Wisser (1974) reports that the 'majority of students perceived the technical discrepancies between class instruction and hospital practice as a conflict between right and wrong'. This dilemma results from the fact that the real value of transferable principles is not appreciated by the students. To illustrate, suppose that a student has learned to perform catheterization with the wearing of sterile gloves in the laboratory. She would find it confusing and frustrating if she were asked to catheterize her patient without the use of sterile gloves in the clinical area. Her confusion and frustration is a result of her inability to transfer the principles of surgical asepsis to this nursing skill. Furthermore, because of this, she is forced to memorize the skill of catheterization in a step-by-step fashion so as to avoid the contamination of the sterile tray. According to Judd, transfer of learning is possible only when the student understands the principles and perceived the possibilities of applying them to other learning situations. Students who have difficulties of transferring their classroom knowledge to the clinical practice are less likely to see the real value of total patient care. They do not perceive the possibilities of applying psychological and sociological knowledge to patient care. For instance, a student may spend most of her time in giving excellent physical care to the dying patient, but would not devote much of her time in interacting with him and in exploring his feelings toward
Transferring classroom learning to clinical nursing practice death. Her unawareness of the emotional need of this patient is due to her inahility to transfer the psychosocial principles and concepts which she learns in the classroom. APATHY Apathy toward clinical practice is the last manifestation of this learning problem to be discussed here. It is the product of the students' inability to transfer learning. Students who demonstrate this learning problem are more apt to receive unsatisfactory grades in their clinical performance than other students. They are likely to be identified by their teachers as either 'borderline' or 'problem' students. They are probed and questioned more frequently by their teachers than are their fellow students. Constant probing, questioning or perhaps punishing generate in them a fear and dishke toward clinical practice. Students may try to cope with this unpleasant experience by developing an apathetic, 'couldn't care less' attitude toward this situation. If this mechanism fails, then a complete withdrawal from the situation may ensue. This withdrawal may take the form of absenteeism. In light of the seriousness of this learning problem, a plan must be formulated to rectify it. Mouly (i960) maintains that the student, the teacher and the curriculum are three vital factors affecting transfer of learning. Based on Mouly's contention, the remedial plan is developed with major emphasis on the teaching process, the student and the curriculum. P E R C E P T U A L SIMILARITIES Both the formal disciplinal theorists and the connectionist theorists believe that transfer of learning occurs automatically. However, the cognitive field theorists would dispute this assumption. They contend that transfer is acquired and that it occurs when there are perceptual similarities between situations. These perceptual similarities are in the form of generalizations (Bigge 1972). They maintain that transfer is facilitated by the teaching of generalizations that have transfer value. They propose that 'a person is in the best frame of mind for transfer to occur when he is aware of acquired meanings and abilities that are widely applicable in learning and living'. The major role of the teacher is to help students understand many widely useful relationships, principles or generalizations. Many teachers tend to teach facts and principles of each subject in isolation. They do not assist the students to see the relationships between them. For instance, students frequently learn the principles related to the care of a depressed patient in the psychiatric unit, but they receive little help to understand the relationships between the care of this patient and the care of a depressed patient in the surgical unit.
Flexibility Travers (1966) proposes that the training for flexibility is one of the keys to promote transfer of learning. He argues that students should have experiences with a
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wide range of problems which share perceptual similarities, yet require different situations. His proposition fulfils Guthrie's interpretation of transfer of learning. Guthrie indicates that the only way to be sure to obtain a specific behaviour in the situation is to exercise that particular behaviour in the situation (Hilgard & Bower 1966). He also asserts that to be able to act in a variety of situations, the learner has to practice in a variety of situations. To illustrate, suppose that a beginning student nurse learns the principles of surgical asepsis. Her ability to transfer these principles would be enhanced if she is given the opportunity to practise these principles in a variety of situations; for example, dressings, catheterizations and intramuscular injections. It is unfair to expect this student to perform sterile technique accurately immediately after her initial exposure to these principles without being given some practice.
Student's active role Improvement in the teaching strategies alone will not guarantee transfer of classroom knowledge to the clinical practice. Since learning is a self-active process, the student must assume an active role in order to promote transfer of learning. Travers suggests that an ideal transfer demands the student's conscious realization that he may apply a specific detail to other situations. Mouly (i960) asserts that a positive attitude on the part of the learner that transfer is possible is essential for transfer to occur. Students need to be committed to the belief that particular facts learned in the classroom study are pertinent in other situations. For instance, a student who lacks a positive attitude that what she learns in the classroom has significance for clinical practice, is less likely to transfer the learned principles related to the care of a post-surgical patient who is in pain to the care of a patent who is experiencing chest pain due to myocardial ischemia. This positive attitude may be acquired through the appropriate use of positive reinforcement. Skinner believes that 'the reinforcement of a response increases the probability of all responses containing the same elements' (Hilgard & Bower 1966). Whenever a student demonstrates the ability to transfer learning, praise for the performance can reinforce the transfer. In time, this student will cultivate a positive attitude that is essential for the enhancement of transfer of classroom knowledge to clinical practice. C U R R I C U L U M DESIGN The curriculum design is the last element to be considered in the formulation of the remedial plan. In order to promote transfer, the curriculum must be designed in such a way so that it has transfer value in terms of the students' goals and purposes. Thus, the learning of sociology and psychology may be of considerable benefit to student nurses, wliile the learning of mathematics may have less value. Furthermore, the promotion of transfer is the responsibility of the teachers who need to spell out in definite terms the specific ways in which transfer is to be
Transferring classroom learning to clinical nursing practice promoted when objectives are formulated for a given course or unit. Kuethe (1968) contends that the ordering of subject matter is necessary to maximize proactive positive transfer. He insists that some forms of learning must take place before other forms can be acquired. Infante (1975) supports Kuethe's contention in her statement that students should be allowed to apply theory to practice only after the theory is learned. She maintains that transfer is made possible only when students are ready; that is, when they possess sufficient knowledge to transfer. In nursing education, the sequence of curricular activities is important if transfer of classroom knowledge to the clinical practice is to be promoted. Its importance can be understood in terms of the law of readiness postulated by Thorndike (Hilgard & Bower 1966). To him, readiness means a preparation for action, rather than physiological maturation. In fact, Thorndike's readiness law is the law of preparatory adjustment. Difficulties or problems related to transfer of classroom information to the clinical practice are commonly encountered by many nursing students. In fact, it seems to be one of the basic causes of academic failure and dissatisfaction with the school. Nursing teachers are led to believe that students are solely responsible for the development of this learning problem. What they do not realize is that they themselves are contributing factors to its development. Thus, the promoting of transfer is focused mainly on the students with negligible attention paid to the teaching process and the curriculum as means to facilitate transfer of learning.
Dearth of knowledge It is not exaggerating to state that the learning problem caused by an inability to transfer learning is not fully understood by nursing teachers. Although many educators recognize the importance of transfer of learning, very few articles have been written about the subject. Similarly, few nursing research studies have been done in this area. Time has come for this learning problem to be explored and understood better by the nurse educator, since they play an important role in the helping of students with this learning problem. The understanding of transfer of learning is critical to the success of the teaching-learning process. It is also critical to the improvement of nursing care. Student nurses who are able to transfer knowledge from one situation to another are future professional nurses who will pursue improvement of patient care by the utilization of prior learning.
References BiGGE M.L. (1972) Learning Theories for Teachers. 2n(l edn. Harper and Row, New York. BREGG E.A. (1958) How can we help students learn? American Journal of Nursing 58, 1120-1122. BRUBACHER J.S. (1947) A History of the Problems of Education. McGraw-Hill, New York. DE CECCO J. & CRAWFORD W . R . (1974) Psychology of Learning and Instruction. 2nd edn. PrenticeHall, New Jersey. ELLIS H . (1965) The Transfer of Learning. The Macmillan Company, New York.
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HiLGARD E.R. & BOWER G . H . (1966) Theories ofLearning. 3rd edn. Appleton-Century-Crofts, New York. HuDGiNS B.B. (1966) Problem Solving in the Classroom. The Macmillan Company, New York. INFANTE M.S. (1975) The Clinical Laboratory in Nursing Education. John Wiley & Sons, New York. KUETHEJ.L. (1968) The Teaching-learning Process. Scott, Foreman and Company, Illinois. MouLY G.J. (i960) Psychology for Effective Teaching. Holt, Rinehart & Winston, New York. ScHUMUCK R., CHESTER N . & LiPprrT R. (1966) Problem Solving to Improve Classroom Learning.
Science Research Associate, Chicago. TRAVERS J.F. (1965) Learning: Analysis and Application. David McKay Company, New York. TRAVERS R . M . W . (1966) Essentials of Learning. The Macmillan Company, New York. WISSER S.H. (1974). Those darned principles. Nursing Forum 13, 386-392.
The inability to transfer dassroom learning to oiinioai nursing praotioe: a learning problem and its remedial plan Julia Wong R.N. B.Sc. M.ScN. Assistant Professor in Nursing, Dalhousie University, Halifax, Canada Accepted for publication 27 September 1978 WONG J. (i^jg) fournal of Advanced Nursing 4, 161-168
The inability to transfer classroom learning to clinical nursing practice: a learning problem and its remedial plan The inability to transfer classroom knowledge to clinical nursing practice is a common learning problem encountered by many nursing students. Manifestations of this problem may involve both the academic performance and personal development of the students: inability to solve problems in nursing situations; inflexibility and rigidity in the exercise of nursing care; fragmentation of nursing care; and apathy towards clinical practice. Because of the seriousness of this learning problem, a plan must be formulated to rectify it. This plan is developed with major emphasis on the teaching process, the student and the curriculum. One of the important roles of a teacher is to help students understand many widely useful relationships, principles or generalizations. In order to enhance transfer, nursing students must be given ample opportunities to apply the learned principles in a variety of nursing situations. Learning is a self-active process; an ideal transfer demands the students' conscious realization that transfer is possible. Students need to be committed to the belief that particular facts in the classroom study are pertinent in other situations. To promote transfer, the curriculum must be designed in such a way so that it has transfer value in terms of the students' goals and purposes. Furthermore, proper sequence of curricular activities is crucial if transfer of classroom knowledge to clinical practice is to occur.
INTRODUCTION It is a matter of observation among educators in the nursing profession that students who have imbibed a great deal of instruction in classroom lectures are unable to relate their instructional knowledge to actual clinical performance. A number of books and articles have been written in relation to this problem, a few of which will be quoted in the course of this paper. In a book entitled Problem Solving to Improve Classroom Learning, Schumuck
et al. (1966) state the matter thus: 'A problem exists when there is a discrepancy 0309-2402/79/0300-0161 $02.00
© 1979 Blackwell Scientific Publications 161
162
J. Wong
between the actual and the desired state of affairs.' When this discrepancy prevails in learning, it may be viewed as an indication of a learning problem. An example may illustrate the point. The actual state of learning for a grade eight student is his ability to spell, while the desired state is a mastery of the grade eight level of spelling. Obviously a discrepancy exists. This discrepancy is an indication of a learning problem which interferes with the student's achievement. Learning problems may assume different characteristics in accordance with the settings in which they occur. In general education, most learning problems are associated with some learning disabilities; for example, inability to spell or write or difficulty in reading. On the other hand, students of the professional disciplines may experience problems or difficulties related to learning which are unique to their fields of study. Bregg (1958) contends that one basic educational problem for every student and teacher in a service-oriented profession is the problem of integration of practice and knowledge. Wisser (1974) reports that fewer than half of the students who participated in her study indicated that the learning of broad principles has been a means of solving the problem of technical discrepancies existing in the clinical area. She charges that the nurse educators are responsible for the development of this problem. She suggests that teachers have put much emphasis on the teaching of concepts and principles in the classroom but fail to help students to synthesize their knowledge and relate this knowledge to clinical practice. Wisser's accusation is valid since the transfer of classroom knowledge to the clinical practice is frequently a problem experienced by many nursing students. Other learning problems such as lack of motivation, difficulties related to problem solving and attitude learning also exist in nursing education. However, this paper will examine only one learning problem which seems important to the nursing students: the inability to transfer classroom knowledge to the clinical practice. Examination and discussion of this problem will follow this order: the concept of transfer of learning, the nature and the characteristics of this problem and the formulation of a plan to deal with it. Ellis (1965) views the concept of transfer of learning as a phenomenon when the experience or performance on one task influences subsequent learning or performance. Travers (1965) maintains that all educational and training programmes are built upon the assumption that human beings have the ability to transfer what they have learned in one situation to another. In fact, schools have no reason for existence other than the ability that teachers have to instil knowledge and teach students to transfer it to events outside the school setting. Thus, students are taught the skill in the writing of English not for the purpose of writing better themes in school, but for the reason that they will be able to prepare effective communications in their daily life. TRANSFER OF L E A R N I N G Among the theories which have been put forward to explain the transfer of learning, the formal discipline theory, the identical elements proposed by
Transferring classroom learning to clinical nursing practice Thorndike and the theory of generalization advanced by Judd are but three (Travers 1965). The formal discipline theory subscribes to the belief that human minds must go through the same kind of vigorous exercise as the muscles of an athlete for their strength. The formal discipline theorists believe that the teaching of difficult subjects will strengthen the faculties of the mind, such as memory, imagination, judgement and reason. Brubacher (1947) assumes that '. . . increase in power from the exercise of a faculty in one field of endeavour was thought to "transfer" automatically or at will to endeavours in other fields. . .' Because of his dissatisfaction with the formal discipline theorists' explanation of transfer, Thorndike proposes the theory of identical elements to account for any transfer that seems to exist. Within Thorndike's system learning is seen as the formation of honds between stimuli and responses. To Thorndike, transfer of learning will occur from one activity involving certain honds to another activity which also involves the same bonds. Judd proposes a somewhat different theory to explain the phenomenon of transfer of learning. According to Judd, transfer depends upon an individual's xmderstanding of the principles or generalizations which are inherent in any learning task. Abstractions, generalizations and applications are vital to his theory. In order to improve transfer, Judd proposes that the student must understand the fundamental principles of a subject; he must recognize the possibilities of applying these principles; he must be provided with the opportunity to employ the generalizations of one problem or suhject to another area.
Problems Difficulties and problems related to the transfer of learned principles to the clinical practice are learning problems encountered hy many nursing students. Wisser (1974) identifies the shift from the technical aspects of the nurse's education to the teaching of principles without the emphasizing of integration as a problem in nursing education today. As a result of this shift, nursing students may hecome superh passers of examinations, hut may be unable to help a troubled patient take heart. Bregg (1958) insists that students of service-oriented professions must he ahle to do more than simply ahsorh content and pass examinations. They must he able to transfer and to relate the learned principles to the nursing practice. Manifestations of the learning prohlem of inahility to transfer classroom knowledge to the clinical practice may involve hoth the academic performance and the personal development of the students. This problem may be recognized hy the students' failure to progress academically or the students' lack of interest in the involvement of the learning process. In general, this learning prohlem may be manifested in the following ways: 1 2 3 4
Inahility to solve prohlems in nursing situations. Inflexibility and rigidity in the exercise of the nursing care. Fragmentation of nursing care. Apathy towards clinical practice.
163
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J. Wong
People tend to view problem solvitig as different from transfer of learning. In actuality, problem solving is an example of positive transfer, since problem solving involves the referring of lov^^er order principles to higher order principles (De Cecco & Crawford 1974). Students who experience a great deal of difficulty in the transfer of learned principles to the clinical practice invariably encounter difficulty in problem solving. Hudgins (1966) reports that one of the characteristics of the poor problem solver is his unawareness of the fact that the knowledge he possesses can indeed be applied to the problem at hand. An example may crystallize this point. A beginning student nurse learns the principles related to meeting the patient's hygiene needs in the classroom. When she is assigned to attend to the needs of an elderly patient who is emaciated and unconscious, she fails to give good skin care to this patient. To be sure, the care of an unconscious patient is a new problem to this beginning student, but if she is able to transfer the knowledge she has learned about the meeting of the patient's hygiene needs, she can meet them adequately, irrespective of his medical diagnosis. Obviously, this student fails to become aware of the fact that the knowledge she possesses can indeed be applied to this novel clinical situation. However, upon probing by the teacher with some appropriate cues and suggestions, she may in fact recognize the information which could be appropriately transferred to the problem. But without the assistance of the teacher, it seems unlikely that the problem would have been solved.
££fects on the student Because of her inability to transfer learned principles and concepts to the clinical practice, the student becomes inflexible, rigid and frustrated in her clinical practice. Wisser (1974) reports that the 'majority of students perceived the technical discrepancies between class instruction and hospital practice as a conflict between right and wrong'. This dilemma results from the fact that the real value of transferable principles is not appreciated by the students. To illustrate, suppose that a student has learned to perform catheterization with the wearing of sterile gloves in the laboratory. She would find it confusing and frustrating if she were asked to catheterize her patient without the use of sterile gloves in the clinical area. Her confusion and frustration is a result of her inability to transfer the principles of surgical asepsis to this nursing skill. Furthermore, because of this, she is forced to memorize the skill of catheterization in a step-by-step fashion so as to avoid the contamination of the sterile tray. According to Judd, transfer of learning is possible only when the student understands the principles and perceived the possibilities of applying them to other learning situations. Students who have difficulties of transferring their classroom knowledge to the clinical practice are less likely to see the real value of total patient care. They do not perceive the possibilities of applying psychological and sociological knowledge to patient care. For instance, a student may spend most of her time in giving excellent physical care to the dying patient, but would not devote much of her time in interacting with him and in exploring his feelings toward
Transferring classroom learning to clinical nursing practice death. Her unawareness of the emotional need of this patient is due to her inahility to transfer the psychosocial principles and concepts which she learns in the classroom. APATHY Apathy toward clinical practice is the last manifestation of this learning problem to be discussed here. It is the product of the students' inability to transfer learning. Students who demonstrate this learning problem are more apt to receive unsatisfactory grades in their clinical performance than other students. They are likely to be identified by their teachers as either 'borderline' or 'problem' students. They are probed and questioned more frequently by their teachers than are their fellow students. Constant probing, questioning or perhaps punishing generate in them a fear and dishke toward clinical practice. Students may try to cope with this unpleasant experience by developing an apathetic, 'couldn't care less' attitude toward this situation. If this mechanism fails, then a complete withdrawal from the situation may ensue. This withdrawal may take the form of absenteeism. In light of the seriousness of this learning problem, a plan must be formulated to rectify it. Mouly (i960) maintains that the student, the teacher and the curriculum are three vital factors affecting transfer of learning. Based on Mouly's contention, the remedial plan is developed with major emphasis on the teaching process, the student and the curriculum. P E R C E P T U A L SIMILARITIES Both the formal disciplinal theorists and the connectionist theorists believe that transfer of learning occurs automatically. However, the cognitive field theorists would dispute this assumption. They contend that transfer is acquired and that it occurs when there are perceptual similarities between situations. These perceptual similarities are in the form of generalizations (Bigge 1972). They maintain that transfer is facilitated by the teaching of generalizations that have transfer value. They propose that 'a person is in the best frame of mind for transfer to occur when he is aware of acquired meanings and abilities that are widely applicable in learning and living'. The major role of the teacher is to help students understand many widely useful relationships, principles or generalizations. Many teachers tend to teach facts and principles of each subject in isolation. They do not assist the students to see the relationships between them. For instance, students frequently learn the principles related to the care of a depressed patient in the psychiatric unit, but they receive little help to understand the relationships between the care of this patient and the care of a depressed patient in the surgical unit.
Flexibility Travers (1966) proposes that the training for flexibility is one of the keys to promote transfer of learning. He argues that students should have experiences with a
165
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wide range of problems which share perceptual similarities, yet require different situations. His proposition fulfils Guthrie's interpretation of transfer of learning. Guthrie indicates that the only way to be sure to obtain a specific behaviour in the situation is to exercise that particular behaviour in the situation (Hilgard & Bower 1966). He also asserts that to be able to act in a variety of situations, the learner has to practice in a variety of situations. To illustrate, suppose that a beginning student nurse learns the principles of surgical asepsis. Her ability to transfer these principles would be enhanced if she is given the opportunity to practise these principles in a variety of situations; for example, dressings, catheterizations and intramuscular injections. It is unfair to expect this student to perform sterile technique accurately immediately after her initial exposure to these principles without being given some practice.
Student's active role Improvement in the teaching strategies alone will not guarantee transfer of classroom knowledge to the clinical practice. Since learning is a self-active process, the student must assume an active role in order to promote transfer of learning. Travers suggests that an ideal transfer demands the student's conscious realization that he may apply a specific detail to other situations. Mouly (i960) asserts that a positive attitude on the part of the learner that transfer is possible is essential for transfer to occur. Students need to be committed to the belief that particular facts learned in the classroom study are pertinent in other situations. For instance, a student who lacks a positive attitude that what she learns in the classroom has significance for clinical practice, is less likely to transfer the learned principles related to the care of a post-surgical patient who is in pain to the care of a patent who is experiencing chest pain due to myocardial ischemia. This positive attitude may be acquired through the appropriate use of positive reinforcement. Skinner believes that 'the reinforcement of a response increases the probability of all responses containing the same elements' (Hilgard & Bower 1966). Whenever a student demonstrates the ability to transfer learning, praise for the performance can reinforce the transfer. In time, this student will cultivate a positive attitude that is essential for the enhancement of transfer of classroom knowledge to clinical practice. C U R R I C U L U M DESIGN The curriculum design is the last element to be considered in the formulation of the remedial plan. In order to promote transfer, the curriculum must be designed in such a way so that it has transfer value in terms of the students' goals and purposes. Thus, the learning of sociology and psychology may be of considerable benefit to student nurses, wliile the learning of mathematics may have less value. Furthermore, the promotion of transfer is the responsibility of the teachers who need to spell out in definite terms the specific ways in which transfer is to be
Transferring classroom learning to clinical nursing practice promoted when objectives are formulated for a given course or unit. Kuethe (1968) contends that the ordering of subject matter is necessary to maximize proactive positive transfer. He insists that some forms of learning must take place before other forms can be acquired. Infante (1975) supports Kuethe's contention in her statement that students should be allowed to apply theory to practice only after the theory is learned. She maintains that transfer is made possible only when students are ready; that is, when they possess sufficient knowledge to transfer. In nursing education, the sequence of curricular activities is important if transfer of classroom knowledge to the clinical practice is to be promoted. Its importance can be understood in terms of the law of readiness postulated by Thorndike (Hilgard & Bower 1966). To him, readiness means a preparation for action, rather than physiological maturation. In fact, Thorndike's readiness law is the law of preparatory adjustment. Difficulties or problems related to transfer of classroom information to the clinical practice are commonly encountered by many nursing students. In fact, it seems to be one of the basic causes of academic failure and dissatisfaction with the school. Nursing teachers are led to believe that students are solely responsible for the development of this learning problem. What they do not realize is that they themselves are contributing factors to its development. Thus, the promoting of transfer is focused mainly on the students with negligible attention paid to the teaching process and the curriculum as means to facilitate transfer of learning.
Dearth of knowledge It is not exaggerating to state that the learning problem caused by an inability to transfer learning is not fully understood by nursing teachers. Although many educators recognize the importance of transfer of learning, very few articles have been written about the subject. Similarly, few nursing research studies have been done in this area. Time has come for this learning problem to be explored and understood better by the nurse educator, since they play an important role in the helping of students with this learning problem. The understanding of transfer of learning is critical to the success of the teaching-learning process. It is also critical to the improvement of nursing care. Student nurses who are able to transfer knowledge from one situation to another are future professional nurses who will pursue improvement of patient care by the utilization of prior learning.
References BiGGE M.L. (1972) Learning Theories for Teachers. 2n(l edn. Harper and Row, New York. BREGG E.A. (1958) How can we help students learn? American Journal of Nursing 58, 1120-1122. BRUBACHER J.S. (1947) A History of the Problems of Education. McGraw-Hill, New York. DE CECCO J. & CRAWFORD W . R . (1974) Psychology of Learning and Instruction. 2nd edn. PrenticeHall, New Jersey. ELLIS H . (1965) The Transfer of Learning. The Macmillan Company, New York.
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HiLGARD E.R. & BOWER G . H . (1966) Theories ofLearning. 3rd edn. Appleton-Century-Crofts, New York. HuDGiNS B.B. (1966) Problem Solving in the Classroom. The Macmillan Company, New York. INFANTE M.S. (1975) The Clinical Laboratory in Nursing Education. John Wiley & Sons, New York. KUETHEJ.L. (1968) The Teaching-learning Process. Scott, Foreman and Company, Illinois. MouLY G.J. (i960) Psychology for Effective Teaching. Holt, Rinehart & Winston, New York. ScHUMUCK R., CHESTER N . & LiPprrT R. (1966) Problem Solving to Improve Classroom Learning.
Science Research Associate, Chicago. TRAVERS J.F. (1965) Learning: Analysis and Application. David McKay Company, New York. TRAVERS R . M . W . (1966) Essentials of Learning. The Macmillan Company, New York. WISSER S.H. (1974). Those darned principles. Nursing Forum 13, 386-392.
