Meaningful Learning

University of Detroit Mercy

December 16, 2015

Arielle Greenlee BSN

Background

David Ausubel introduced his first studies of meaningful learning in 1963 (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015). Ausubel placed considerable interest on what the student already knows as the primary determiner of whether and what the student learns next (Hannum, 2015). The process of meaningful learning allows the learner to incorporate content into their cognitive structure, therefore becoming cognitive content (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015). Ausubel viewed learning as an active process, not solely responding to one’s environment (Hannum, 2015).

Active learning methods are rarely implemented in the professional work environment and studies indicate that most teachers continue to prefer traditional teaching methods (Bhardwaj, P., Bhardwaj, N., Mahdi, F., Srivastava, J.P., & Gupta, U. 2015). In addition, the literature reveals many barriers to active learning. For example, students come to the learning environment unmotivated and do not take responsibility for their learning. Current students are expected to simultaneously grasp, analyze, and critically think through multiple areas of complex subject matter. It is imperative that learning be meaningful for the learner.

Review of the Literature

Few studies have been done on pedagogy in professional healthcare settings (Pagnucci, N., Carnevale, F.A., Bagnasco, A., Tolotti, A., Cadorin, L., & Sasso, L. 2015).. The literature exemplifies the urgent need to devote greater attention to pedagogical aspects of education in clinical work settings (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015). Further review reveals the need for teachers to seek appropriate teaching methods that enhance clinical decision-making and further allows for continuous, self-centered learning (Pourghaznein, T., Sabeghi, H., & Shariatinejad, K., 2015). The literature also highlights the importance of teachers using up-to-date, active, learner-centered teaching methods with careful consideration in selection of the best teaching method for the individual learner (Pagnucci, N., Carnevale, F.A., Bagnasco, A., Tolotti, A., Cadorin, L., & Sasso, L., 2015).

The implementation of new pedagogical strategies that view students as prime actors, promoting the student(s) to take responsibility for their learning, remains rare (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015). Further, seeking up-to-date pedagogical methods to enhance clinical decision making and self-centered learning is difficult (Pourghaznein, T., Sabeghi, H., & Shariatinejad, K., 2015). Despite understanding the benefits of implementing interactive teaching methods, preference is still towards traditional methods in part due to cost and/or time effectiveness (Pourghaznein, T., Sabeghi, H., & Shariatinejad, K., 2015). Undoubtedly, consistent implementation of interactive methods of learning will require additional education.

Interactive learning styles are shown to increase students’ desire and motivation to learn and favor greater involvement by the learner (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015). Pedagogical methods that lead to extensive interaction between the students and teachers are more effective in terms of satisfaction, the ability to retain knowledge, and increased responsibility taken by the student (Pagnucci, N., Carnevale, F.A., Bagnasco, A., Tolotti, A., Cadorin, L., & Sasso, L., 2015). Case-based learning, or problem-based learning (PBL), is an interactive teaching technique that includes the teacher presenting a pre-prepared problem and students study, individually and collectively, to solve the problem (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L, & Soares, M.J.G.O., 2015). Arousing interest in the student early on by requiring them to solve problems can act as learning triggers and aide the student to critical thinking and making decisions, an imperative element of bedside nursing care (Sousa, A.T.O., Forminga, N.S., Oliveira, S.H.S., Costa, M.M.L., & Soares, M.J.G.O., 2015).

Hypothesis

There are many challenges to providing interactive, learner-centered teaching sessions. Traditional pedagogical methods have repeatedly been shown to be the antithesis of effective learning environments. Pourghaznein et al. (2015) found the retention of content to be significantly lower following lectures compared to more interactive and modern forms of pedagogy. Of note, up to 80% of lecture material is forgotten by the learner within eight weeks (Pourghaznein, T., Sabeghi, H., & Shariatinejad, K., 2015). Mentioned previously, students have very good perceptions of interactive teaching methods and performed better if they were taught using an integrated approach (Bhardwaj, P., Bhardwaj, N., Mahdi, F., Srivastava, J.P., & Gupta, U., 2015). This study aimed to establish a meaningful learning session for telemetry Registered Nurses on the ‘basics of acute coronary syndrome’, incorporating learner-centered and interactive pedagogical techniques.

Study Design

This was a planned field research project that took place at California’s central valley Community Regional Medical Center (CRMC). CRMC provides the highest level of care in the area. The hospital is applauded for its ongoing investment in technology and leading-edge treatments. CRMC is the leader in cardiac services and prides itself on evidence based patient care and outcomes. The facility is a teaching institution and strives to provide evidence based treatment methods with an ongoing effort to provide its staff with continuing education opportunities. Twice a year, nurses in cardiovascular services attend a formal training consisting of health related teachings, technological update overviews, new service orientation, and other general information.

Material was gathered from PubMed and Ebsco databases with search terms including: acute coronary syndrome (ACS), heart disease, evidence based acute coronary syndrome (ACS) treatment, heart failure, nurse and physician interaction, and multi-disciplinary care. Material was reviewed for important concepts and evidence based guidelines. The participants included approximately 40 telemetry Registered Nurses with varying levels of experience. Written permission was obtained from the facilities unit director.

The teaching session included exercises, demonstrations, small group led discussions, case based learning, and online resources, including the use of videos, evidence based algorithms and diagrams. Materials were presented to the students in an effort to motivate the student and further promote interaction and engagement.

Students were provided a breakfast upon arrival and were given time to settle in. A brief orientation commenced including a schedule for the day and goals for the class. Before a formal introduction to the specific ACS course outline, students were told to stand at their seats, turn to their neighbor, and share a piece of information they already knew about ACS. Students were reminded that no formal PowerPoint slides or handouts would be provided for the course; resources would be available upon request.

The class began with an informal display of two videos. The first video intended to set a more relaxed atmosphere and included a group of healthcare professionals singing a commonly recognized song that had cleverly been re-worded to include key concepts associated with ACS. The second video was an educational film on the pathogenesis of coronary disease, with use of 3D imaging and modern automation. Upon completion of both videos, students were assigned in small groups, pre-developed case studies and corresponding questionnaires were provided. Students were able to collaborate and work through the case studies in their groups. Students externalized personal knowledge in their preassigned groups to formulate plans of care. Interaction with group members was encouraged and questions were answered individually and collectively. Plans of care were then shared as a class and students were able to receive feedback from their peers.

Towards the later end of the course an American Heart Association (AHA) evidence based treatment algorithm for ACS was presented. Students worked through the algorithm interactively to include assessment and diagnosis, medical and non-medical interventions, and nursing considerations. Knowledge students gained earlier in the course by completing the case scenarios was integrated while working through the AHA algorithm.

Pre-developed questions on covered topics and areas of interest were presented to the class as a whole towards the end of the course. Treats and prizes worked to provide incentive and motivation for students to become active participants. Discussions and follow up questions were addressed.

Data Collection

To assess the students’ experience of meaningful learning, students were encouraged to fill out a provided individual evaluation and the Critical Incident Questionnaire (CIQ), developed by Stephen Brookfield (Brookfield, 2013), upon completion of the course. The CIQ has been noted as an accurate method for finding out how students are experiencing their learning. Evaluations were also gathered from each participant with scores on a scale of 1–5 (1 — Not Good — 5 — Excellent). The following areas were graded: knowledge of subject matter, presentation skills, communication/interaction skills, stimulating, and responsiveness to questions.

Results

Speaker

Arielle Greenlee RN

ITEMS

5

Excellent

4 Very Good

3

Good

2

Fair

1

Not

Good

Acute Coronary Syndrome

1. Knowledge of Subject Matter

3.9

2. Presentation Skills

3.7

3. Communication/Interaction Skills

3.8

4. Stimulating

3.7

5. Responsiveness to Questions

4.1

The CIQ filled out by individual students revealed a vast majority (82.5%) of students felt most engaged in the course during their interaction with small groups while others (15.5%) felt most engaged while answering questions as a cohort. Most participants acknowledged they felt most confused during the video presentations (79.8%). The ‘most surprising’ aspect of the course was not identified and instead was answered N/A (not applicable).

Both methods of evaluations reveal that interactive learning methods, including the use of case-based learning, were viewed favorably in terms of stimulation and interaction. Similarly, students enjoyed the questions presented at the end of the course when they were able to win prizes for active participation.

Discussion

Registered Nurses are expected to keep their knowledge up to date with the ability to integrate knowledge into clinical practice despite evolving treatment recommendations and practice guidelines (Aglen, 2015). Teaching activities are frequently not learner-centered and consequently often revert to lecture or independent review of material.

The evaluations provide helpful feedback but further study is required to determine the ability of students to integrate material to enhance clinical decision making. Experience level coming into the course varied and could have played a factor in student participation and engagement in the course. As previously noted, individual learning styles need to be recognized and this course was unable to preemptively define and accommodate each participants learning style. Many educators continue to view non-traditional teaching methods as ineffective, and it cannot be dismissed that some students may feel similarly; this commonality may have influenced feedback indirectly.

Conclusion

Interactive, learner-centered teaching methods promote engagement and were subjectively scored as stimulating. Further study is required to identify the ability of the student to integrate learned material to enhance clinical decision-making.

References

Aglen, B. (2015). Pedagogical strategies to teach bachelor students evidence-based practice: A

systematic review, Nurse Educ. Today, http://dx.doi.org/10.1016/j.nedt,2015.08.025

Brookfield, S.D. (2013). Critical Incident Questionnaire. Obtained from stephenbrookfield.com

Hannum, W. (2015) Obtained from http://www.theoryfundamentals.com/ausubel.htm

Bhardwaj, P., Bhardwaj, N., Mahdi, F., Srivastava, J.P., & Gupta, U. (2015). Integrated teaching

program using case-based learning. Int J Appl Basic. Med Res.2015 Aug; 5(Suppl 1):

S24-S28 doi: 10.4103/2220–516X.162262

Pagnucci, N., Carnevale, F.A., Bagnasco, A., Tolotti, A., Cadorin, L., & Sasso, L. (2015). A

cross-sectional study of pedagogical strategies in nursing education: Opportunities and

Constraints Toward Using Effective Pedagogy. BMC Medical Education 15:138. DOI 10.1186/s12909–015–0411–5

Pourghaznein, T., Sabeghi, H., & Shariatinejad, K. (2015). Effects of e-learning, lectures, and

role playing on nursing students’ knowledge acquisition, retention and satisfaction. Medical Journal of the Islamic Republic of Iran, Vol. 29:162.

Sousa, ATO, Formiga N.S., Oliveira S.H.S., Costa M.M.L & Soares, M.J.G.O. (2015). Using the

theory of meaningful learning in nursing education. Rev Bras Enferm, 2015;68(4):626–35. DOI: http://dx.doi.org/10.1590/0034-7167.2015680420i

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