A Pedagogical Model for Teaching and learning in Nursing
Hanne Elisabeth Helleshøj*
Social-og sundhedsskolen
Fredericia-Vejle-Horsens, Social- og sundhedsskolen Fredericia, 6 julivej 67,
7000 Fredericia, Denmark
*Corresponding author: Hanne Elisabeth Helleshøj, President, Social- og sundhedsskolen Fredericia, 6 julivej 67, 7000 Fredericia, Denmark. Tel: +45-21629493/ 79211340; Email: hhe@sosufvh.dk
Received Date: 16 December, 2018; Accepted Date: 12 February, 2019; Published Date: 18 February, 2019
Citation: Helleshøj HE (2019) A Pedagogical Model for Teaching
and learning in Nursing. Int J
Nurs Res Health Care 2: 165. DOI: 10.29011/ IJNHR-165.100065
Abstract
At the Basic Health Care College of
Fredericia - Vejle - and Horsens in Denmark we offer health care programs
on different levels. Apart from being a College we are also together with two
other Basic Health Care Colleges, SOSU Nord and SOSU Fyn - a Center for Welfare
Technology appointed by the Ministry of Education in Denmark. Being a Center
for Welfare technology means that we are researching, developing and
disseminating knowledge about:
1) Welfare Technology aiming
at facilitating daily living for patients whether they are in their own homes,
in nursing facilities or in hospitals.
2) Teaching and learning
technology, which means including modern educational technology in our programs
and classes.
3) Simulation. Simulation is a
method with three stages, briefing, scenario and debriefing, where we aim at
creating a care situation that is as close to real patient situations as
possible. We do this in order to:
· Give students a better
basis for real practice situations.
· Train hands on in order to
develop routine.
· Establish connection
between knowing that, knowing why and knowing how.
· Secure patient safety.
· Secure student engagement.
At our college and in the knowledge center we
conduct simulation in a way where we integrate modern welfare technology aiming
at facilitating life for patients, modern educational technology - in our
simulation scenarios. This means that we have scenarios where welfare
technology incurs. It could be at care situation where different assistive
devices are used in the care situation. We want students to carry out credible
and realistic care situations so that they get experience in handling the
welfare technology they meet in real practice. That is enhanced by working with
scenarios that include welfare technological solutions. In briefing we use
educational technology including internet access where the students can search
for further information they need in order to perform the scenario. Students
can enlarge their theoretical background on symptoms, care and treatment to be
well prepared for conducting care and therapy, and be prepared also to offer
reasons for their care and actions. We also include technology in debriefing as
the whole scenario is filmed. Filming makes it possible to maintain dialogue on
what actually happened in the scenario.
Thereto we want to engage students in their
own learning process. Engagement is facilitated by technology and simulation.
We want to teach in ways that allow for different learning styles. Simulation
as a method including technology provides this. The Basic Health Care
College of Fredericia, Vejle and Horsens has the following MISSION:
“To qualify professionals, who on continual basis develop their professionalism
proportional to assignments and challenges in present and future practice.” And
we have the following VISION: “To be a professional and development oriented
organization, known for an attractive and vivid learning environment plus high
pedagogical-didactical standards.” Having a mutual accepted pedagogical
framework is a way of meeting our mission and fulfilling the vision.
· On an organizational level,
where standards are discussed and determined.
· On departmental level where
standards are implemented.
· On teacher and classroom
level where standards are in function and evaluated in connection with students
‘outcomes.
· In collaboration with
clinical partners.
At our college as well as in Center for Welfare Technology of Western Denmark, we will research and develop knowledge on how technology and simulation can facilitate education and training of health care professionals, who are able to face challenges in health care now and in the future in order to continuously develop their own practice.
Introduction
A Pedagogical Model – Students Meaningful
Involvement in Health Care Education based on a Mutual Understanding of
Challenges among Faculty Members and Development of Engaging Methods.
Presentation of a mutual teaching and learning approach, based on at
Pedagogical Model at the Basic Health Care College of Fredericia-Vejle-Horsens
in Denmark (Figure 1). In Denmark we are facing challenges with meeting the
expectations of the young generation in Health Care Education. These challenges
may be related to expectations of a variety in teaching methods and personal
learning activities - versus or in combination with the expectations of the
employers regarding learning outcomes of both knowledge, skills, attitude - and
expectations of ability to find new solutions to known challenges as well as
new solutions to new challenges. Thereto the nursing programs are outcome
based, and the outcomes are described in a complex and taxonomical high level
relative to the length of the programs. Thus, we are facing complex and mixed
expectations and challenges, leaving the lecturers with a complex assignment
that they may find troublesome facing individually.
At our school - The Basic Health Care College
of Fredericia, Vejle and Horsens - we therefore have implemented a mutual
framework for implementation of an effective pedagogy. A model called the
Pedagogical Model. The model is accompanied by a written description of our
mutual pedagogical, didactical platform/framework.
The Pedagogical Model (Figure 2)
I developed the pedagogical model on basis of
a very much used concept in European Pedagogy, namely the pedagogical triangle,
which states that learning in a professional context is an outcome based on
some sort of relation between a teacher, a student and the content. However, as
students change and the demands for at continuous development of professional
teaching increase, I felt the need to clarify, develop and explain the areas
that lie between the teacher and the content, between the student and the
content and between the teacher and the student - on new preconditions. Also by
emphasizing the areas between somebody and something, I turn the triangle
relational, meaning that also the perception and the quality of the relation
mean something for engagement and ultimately learning.
Thus, I end up with three new areas
explaining characteristics of the connection/relation between teacher and
contents, what constitutes and encourage the field between student and contents
and lastly how the relation between teacher and student in a professional
relation can be built - in nursing education. These three areas I have named
Expertise, Relevance and Relation. And I do not only describe that learning is
the outcome of all the efforts regarding expertise, relevance and relation, but
learning is based on the concept, that in order to learn at all you need to be
engaged in something meaningful and in a meaningful way. Therefore, the center
text describes meaningful involvement as a basis for learning. By that, I am
also emphasizing that in order to secure the meaningful involvement you need
expertise, relevance and relation as well as a teacher, a student and the
contents.
Expertise
From the Figure 2, the area between the
teacher and the professional content, I describe with the term EXPERTISE. I
have developed this term from the concept og professionalism from my great role
model (I have actually met him and written book chapters with him) [2].
Expertise Covers Professional knowledge, Professional didactical
knowledge, Common didactical knowledge and Pedagogical knowledge
Professional Knowledge: Professional
knowledge means that you know your profession. You know your subject, topic or
if you teach or instruct practical aspects of a profession - your trade. In
short - you need to know what you´re talking about.
Professional Didactical Knowledge: Professional
didactical knowledge means that you know how to teach others your profession or
your trade. Professional didactics is about:
. Goals, objectives
. Contents
. Methods
. Evaluation
Common Didactical Knowledge: Common didactical
knowledge is about understanding how your topic or subject is related to other
subjects that is part of the program the student is enrolled in. In what order
should topics come? Which elements are necessary for the progression in learning
and in what order? What is the relevance for the student in your subject?
Pedagogical Knowledge: Pedagogical knowledge
is about knowing - in addition to the afore mentioned knowledge areas - about
the students. What do they already know? What are their learning strategies,
their motivation etc - and about making sense of your professional, your professional-didactical
and common didactical knowledge while you observe not just any single student
but groups of students?
Relevance
Back to the Figure 2, As many professional
programs consist of many different subjects and both theory and practice,
relevance is of the utmost significance. And this is relevance from the
perspective of the student. In my pedagogical model, I highlight objectives,
understanding of objectives and attaining objectives as a way of securing
relevance. The objectives should be realistic and possible to attain. In
Denmark all educational programs in nursing education are objective oriented
and sometimes described in a way that the students are not able to decode.
Therefore, teacher and students need to talk about the purpose of working with
a given topic and also why to work with it in the chosen way [2].
There should be high objective achievement
and the students should realize it. This means that the way the teacher teaches
and the way the students work with the contents should enforce goal achievement
- and that the students either experience goal achievement or be told that they
have reached the goal [2]. And last but not least: The behavior described
in the objectives should be practiced in class. This means, that if the goal
describes that the student is able to analyze a given text, analyzing texts
should be practiced - or if the goal describes that the student be able to do
personal hygiene with at patient - practicing personal hygiene should be on the
agenda [2]. The better connection there is between objectives,
contents and method the better chance for perceived relevance. Objectives are
normally described within the cognitive, the psychometric domain = knowing
that, knowing how and why plus having an attitude towards it. But alas - in
modern days - you might rightly ask: “Are the professional objectives factually
the only objectives we work with, or might there be a new agenda”.
21st Century Skills within Nursing Education
The OECD has supported the 21st Century Skills. I
find the 4 C´s within these described skills extremely interesting for nursing
education. The 4 C´s are: Creativity, Critical thinking, Collaboration and
Communication. These skills are not new, but the expectation is that they will
be more needed in the future due to the way society is changing because of
technology. Employers confirm to demand high professional standards, but they
also want more. They want people who can adapt, see connections, innovate,
communicate and work with others - and therefore we need to pay attention to
these skills and include them in our professional programs and in order to
create relevance between the contents and the students - also in our
professional objectives and lastly also include them in the educational
activities.
Is this inclusion new? No not necessarily. In
Denmark we have always included also more personal valued characteristics like
empathy, ability to listen, being able to give something your full attention
etc. - in our assessment of good nursing practice and also in the progression
of the student´s learning - but the question is whether the general education
system is designed to promote skills like critical thinking, creativity,
communication and collaboration? So, if they in future should appear openly in
our professional objectives how should we teach them? (Table 1).
Dilemmas
Daisy Christodoulou [3] who is head
of Assessment at Ark Schools in the UK and who has researched the connection
between 21st Century Skills and
teaching concludes about the above described dilemmas, that you need to teach
the 21st Century Skills
directly, they will not have any implication for you learning when taught in
the abstract. It is a good idea for several of the skills to work project not
subject oriented - but again of course that will depend on the objectives - as
objectives should be realistic and possible to attain. It is still important to
focus on deep work. Even though we would want to teach nurses to multitask, it
is a research result that multitasking while learning impairs performance. “We
remember what we focus on”. Technology may enhance deep learning but only if it
helps focusing attention. Again, if objectives are described so they express
what the student should reach, if the goal is understood by the student and if
the activities in the classroom mirror the goal - it is possible to focus
attention.
It is still important to focus on teaching
knowledge. It takes knowledge to gain knowledge. One of the theoreticians I
studied in my PhD, Niklas Luhmann [4] says: It takes complexity to overcome
complexity, which means the more you know, the more possibilities you have to
gain new knowledge, but also to process this knowledge and make it meaningful -
so it is a fact that you can´t teach students to find and use knowledge unless they
know something to begin with.
Furthermore, Daisy Christodoulou also gives
the following statement: “Doing isn´t learning and performance isn´t learning”
- there is no powerful learning effect. By doing and performing alone a
behavior does not come into long-term memory. Therefore, it is beneficial to
include the 21st Century Skills and
teach them directly in education. If critical thinking in relation to the
before mentioned goal about being able to do personal hygiene with at patient -
practicing personal hygiene should be on the agenda as well as practicing
critical thinking, which among a lot of possibilities could be about how to
perform the task, what to observe while doing it, what to change if the
situation demands it and these last goals should also be verbalized in the
learning session - behavior described in the objectives should be practiced in
class, there should be high objective achievement and the students should
realize it. And what do 21st Century Skills mean in relation to the expertise
that is essential in describing the field between teacher and content? Again, I
shall refer to Daisy Christodoulou, who states that: “The practice of a
profession is not the same as teaching to practice the profession” - hence my
description of professional knowledge, professional didactical knowledge,
common didactical knowledge and pedagogical knowledge.
Relation
Back to Figure 2, Over the years
there has been different views upon the relation between teacher and student.
In what we in DK refer to as “The black school” the relation was based on fear
and fear induced respect, in the “Laissez-Faire” period it was based on the
belief that the student knew best, and that the teacher should preferably as
also Pink Floyd states it: “leave the kids alone”. There has also been a long
period where the relation was perceived as a relation between friends or
relatives with for example a mother/father metaphor. In nursing education there
may also be some teachers who tend to regard the student as a patient.
I believe in none of these! Instead I, and again with reference to Erling Lars
Dale [2], propose that the relation between teacher and student should be
based on:
· Asymmetric competence.
· Communication, Care,
Upbringing/Manners.
· Ethical guidelines;
Interest in Validity, Presentational Knowledge, Fairmindedness, Drive.
Asymmetric Competence
Asymmetric competence means, that the teacher
is and should be superior:
· Regarding the contents -
he/she knows more.
· Regarding the methods -
he/she knows more about how to learn.
· Regarding the objectives -
he/she should support the students understanding of objectives, secure it is
possible to work on attaining the goals and facilitate the students
‘understanding of how and when they have reached the goal.
Communication, Care and Upbringing/Manners
Communication: Communication here means
that the teacher should know how to present the content, how to stay on track,
how to make meaning of contributions from the students, how to make the
difficult content understandable for all students - and if necessary CONCLUDE.
Care: Care - not in sense of caring for a
patient, but caring for the contents and the student as a learner.
Upbringing/Manners: Upbringing/manners -
meaning a focus on making the student ready to go to and to be in school, and
telling him if his behavior is not acceptable - enhancing collaboration.
Ethical Guidelines
Interest in validity: Interest in validity
[5] means that the teacher should have a genuine interest in the topic
he/she is teaching, in a way so that he is a teacher in “The first person”
(Figure 3). In Denmark we use the phrase that you burn for your subject - the
students can and should expect that, and it helps create meaning for the
student.
Presentational knowledge: Presentational knowledge
is about not just methods, but also about dramaturgy. How to use yourself, your
voice and your educational materials in teaching.
Fairmindedness: Fairmindedness - means
that all students should have the same possibilities and rights in
the classroom.
Drive: Drive - any teacher should
be able to handle disappointments, disagreements and potential setbacks.
Meaningful Involvement and Learning
Back to the Figure 2, the contents, the
teacher, the student and the expertise, the relevance and the relation should
together secure the meaningful engagement or involvement that is fundamental
for learning. Meaningful involvement is a way of insuring meaning. My concept
of learning is that it is a process and a result based on energy to learn. This
energy again is maintained and renewed by the students experiencing that they
learn, which they know by reaching the objectives. It gives you energy to say:
Now I know or now I can. The result of the learning process or learning in
itself can be documented by the students’ ability to:
· Communicate - which means
being able to state or explain his or her knowledge on the respective
taxonomical levels.
· To demonstrate - which
means being able to do or practice again on the respective taxonomical levels
· To produce - which means to
contribute to the contents of what is happening in the classroom. Producing can
be about producing something material as in at written assignment, but in
educational context it will often be about producing solutions new or known to
problems experienced in class or in practice.
Working with meaning has a special
significance in vocational education and training. In Denmark we have a dual
system meaning that school based, and workplace or practice based
teaching/instructing are two different ways of structuring educational programs
(Figure 4). But the point is - they are of equal ranking. Though there over the
years a lot of initiatives have been taken to develop new ways of organizing
educational programs it is for DK a fact that dual programs such as nursing
education in DK is divided in different “Learning Rooms” based on different
logics and characteristics and with different possibilities for learning.
Although different hybrid forms between the
two “Learning Rooms” are possible it is still due to individual reflection that
a connection between theoretical knowledge and practical proficiency will
manifest itself. My point here is that a way of securing meaning is about
showing the students what something is useful for, showing them how and what to
do and why something is essential to know and learn. And we have a wonderful
method especially designed for that, which is called SIMULATION.
Simulation -Structure, Content and Method?
(Figure 5)
Simulation as A Structure
I have earlier stated that simulation is a
method. But is that the only truth? Could one argue that simulation also is a
structure, that means a way of constructing or structuring education? In that
respect simulation is a different setting for teaching and learning than
schoolrooms or clinical settings. By understanding simulation as a new
structure or a new setting for learning you gain possibilities for learning
based on:
· Fundamental basis in a
professional “Real” nursing situation.
· Possibility for acquiring
experience in order to manage a professional situation in future practice by
training the first steps in professional excellence - and the first steps in
becoming an attractive employee in modern health care.
· Possibility for acquiring
experience also in the most complex patient situations.
· The teacher can plan and
effect a learning situation and manage the environment in a way that enhances
learning possibilities.
· Simulation allows for focus
on sub-elements as well as an integral whole.
· You can repeat until a
skill is learned.
Simulation understood as a structure is about
offering conditions for learning in a well prepared, rooted and appropriate
way. Simulation as a structure is a way of establishing a new “Learning Room”.
This again means that the setting facilitated
by simulation could be characterized by the following statements:
1. Learning happens as a
result of both communication/language and practical training.
2. There is a possibility to
reflect theoretical knowledge into practice - and to link theoretical knowledge
to practical skills.
There Is a Possibility to Learn Via
· Forward looking reflection
(briefing), reflection-in-action (scenario) and reflection-on-reflection-in
-action (debriefing).
· Skills practice in
sheltered environment followed by reflection-in action,
reelection-on-reflection-in-action and general critical thinking.
· Meaningful engagement and
prompt objective achievement.
· Meaningful engagement that
enhances energy to learn.
· Knowledge that means that
you may reflect and reason with theoretical knowledge bur also with what you
experienced and learned in simulation.
Simulation as Content
Traditionally the contents cover the
professional subject-matter and substance the students work with. Could
simulation be considered a content?
In that case simulation would be a content
that it is possible to keep stable and unchanging. In high tech simulation you
can program the mannequin to have the same symptoms and react in the same way
over and over. That again means that the student can repeat and train the same
situation again and again - if needed. One could therefore argue that
professional content presented and processed as simulation would be kind of an
interactive content, that enhances engagement and thereby learning. The content
can thus be tailored and personalized to every single student.
Simulation as A Method
The pedagogical phrase method traditionally
means: Adequate procedure in order to reach a goal. Procedure
covers both the activities the teacher plan for him-/herself and the activities
the teacher plans for the students plus the principle education rests upon: Is
there a movement from general to specific or the other way around: From
specific to general. Thus, simulation can be argued to be a pedagogical method,
that is beneficial in order to reach goals, where obtaining skills and
reflection - i.e. forward looking reflection (briefing), reflection-in-action
(scenario) and reflection-on-reflection-in-action (debriefing) - is the
expected outcome. Simulation is a method that makes it possible to secure
professional development and progression in skills, knowledge and attitude plus
involving personality and character. I therefore prefer to understand
simulation first and foremost as a method.
Conclusion: Pedagogy - Simulation - Learning
and How to Develop Innovative Practice
With this headline I shall try to conclude
how - in my opinion - the pedagogical model contributes to innovation in
education. I shall do that by asking two questions:
1. What is innovation in
teaching?
2. How does the presented
framework support innovation in education?
What is Innovation in Teaching?
In my point of view innovation in teaching
starts with the question: What is best for the learner or the learners?
Innovative teaching practice is developed by continuously asking this question
and reflect, revise and remix accordingly.
To reflect, revise and remix takes expertise
and a mutual framework to have in mind - in order to go in the same direction,
setting a stage that is well established and constant - so that teachers know
the framework they reflect with and revise and remix within.
What is Best for Learner?
I strongly - as presented before believing in
meaningful engagement. It takes engagement and mental or/and bodily activity to
learn nursing. But I also strongly believe in differentiation. This means that
I respect that what is best for one learner not necessarily is best for
another. Thus, we differentiate. This can be done on:
Structure: Dividing the student group, change between
working alone or in smaller or bigger groups. Let the students who actually did
their homework before coming to class work together, and those who only
prepared so-so work together. Differentiation can also be done on:
Contents: Allowing the students to work with
different contents, more or less challenging texts, different and more
challenging or complex patient situations etc. - but of course within the
context defined by the objectives. However, in DK we are by law required to
offer programs for talented students - as well as we by law are required to
work for retention of all students. And finally, differentiation can be done
on:
Method: Making sure that you let the students
work with the contents in different ways. Maybe we could move from problem
based learning to challenge based learning? By that I mean giving the student a
reason for learning. This could be done by asking a student what challenges
he/she sees in order to reach a specific goal, what is your personal learning
objective (i.e. what do you need to learn in order to reach the goal - and how
can you work with the contents in order to obtain it?)
If Learning Is Not Only Performance or
Communication - What Is It?
I believe that by a good teaching - in school
based and practice based settings - you can acquire, which means that you may
be able to reproduce, perform and explain. You may also be able to convey this
knowledge whether it be mental or bodily to other situations - but in
collaboration with your teacher or fellow students you might collaborate and
facilitate a reflective process that enhances learning - from an isolated
incident, over experience to reflected knowledge that can be produced when
needed - in any given situation. So innovation in teaching is about developing
teaching, changing beliefs and thus changing teaching behavior - with learning
as the superior purpose.
So: How Does the Presented Pedagogical
Model Support Innovation in Education?
My experience is that having the model and a
mutual framework facilitates all development.
1. In the classroom and in
relation to the students - because you always know whether any given changes
fall within or outside what we understand by good nursing education, not just
because we have the model but also because we have the written description of
our mutual pedagogical, didactical framework.
2. On an organizational level
because descriptions of responsibility and competence for faculty are related
to the framework and described in a development plan. These plans are formally
discussed between head and faculty member every other year. Informally when
needed.
3. Regarding our classrooms
and general learning environment. Differentiation in structure, contents and
method may require new settings.
We do use new technology - in the classroom,
interactive boards, technology driven devices that support different learning
styles, visual, aural, kinesthetic, active or? We also use new technology to
secure that our students actually produce, which means that they are actively
contributing to what is happening in the social relationship that surrounds
learning. We are big on simulation. We have a whole ward in the hospital where
we do both low and high-tech simulation. And we have different classrooms,
rooms for reflection and deep work in groups or individually. We are in the
process of introducing holograms.
Figure 1: Presentation of a mutual teaching and learning
approach, based on at Pedagogical Model at the Basic Health Care College of Fredericia-Vejle-Horsens
in Denmark.
Figure 2: Pedagogical Model [1].
Figure 3: Interest in validity.
Figure 4: Two different ways of structuring educational programs
[6].
Figure 5: Simulation -Structure, Content and Method? [1].
Should We? |
Or
Should We? |
·
Teach directly? ·
Teach projects not subjects? ·
Embrace multitasking? ·
Not teach knowledge but teach how to find knowledge? |
·
Teach indirectly and in the abstract? ·
Keep traditional subjects? ·
Focus on deep work? ·
You can´t teach students how to find and use
knowledge unless they know something to begin with! |
1.
Helleshøj H (2015) Simulation i sundhedsuddannelserne, København:
Munksgaard 2015.
2.
Dale EL (2012) Pædagogik og professionalitet. Aarhus:
Klim 2012.
3.
Daisy C (2016) 21st
century skills: what are they and how can we teach them? 2016.
5.
Dale EL (1999) Pædagogisk filosofi. Århus: Klim 1999.
6. Helleshøj H (1998) Sygeplejefagets pædagogiske dimension. I: Sygeplejefag, refleksion og handling (red.) Lyngaa J, København: Munksgaard 1998.