Bassendowski, S. & Petrucka, P. (July, 2016). Resetting nursing education. Online Journal of Nursing Informatics (OJNI), 20(2), Available at http://www.himss.org/ojni
This paper explores the need for resetting nursing education and discusses the impact and implications of exploring nursing education’s vision, focusing on students’ needs, incorporating technology into teaching and learning spaces, and connecting the capacities of current students to new instructional strategies. The article discusses the concepts of change and upcycling of instructional strategies. Educators need to reflect on the implications of incorporating technology into their teaching and learning spaces, be thoughtful about choices, and proceed through the disruptive process with a clearly determined pathway. There are opportunities and challenges when using technology within a teaching context, but faculty commitment and a belief that technology contributes to change are essential for success. Nursing students have always been encouraged (and expected) to learn how to identify health and illness patterns, to research client data, and synthesize this information for better health outcomes. These experiences teach them how to accumulate, analyze, and select data to safely provide or improve client care. Yet, the implications of this approach today often are contrary to how Generation X and Millennial students have learned about making choices. The paper describes an example of an upcycled instructional strategy (Choose Your Own Nursing Adventure) that is more congruent with the technological expectations of today’s students than a paper-based instructional strategy. Overall, resetting nursing education should make a difference in the relationships of students, educators, and clients and help to improve health care outcomes.
Scenario: I recently attended an art show presented by graduates from a university in London, England. I was amazed at the creativity and the innovation shown by the individual graduates regarding their artistic works. I stopped at one display, had a discussion with a young artist, and during this discussion heard the word – upcycling – for the first time. She explained to me that she went to flea markets looking for one-of-a-kind china pieces (teacups with no saucers, sugar bowls with no lids, or large dinner plates with no matching pieces). She then adds her unique, bold, abstract art to the selected piece, re-fires the piece in a kiln, and then sells the one-of-a-kind artistic piece as part of the upcycled/reset concept.
Scenario: In 2015, the Gates Foundation released the results of a survey that focused on faculty attitudes toward new teaching technologies and approaches. The results suggest that faculty members are aware of new developments in teaching, but that less than half implement them in their classrooms (FTI Consulting, 2015). Approximately 29% of respondents said that they had adopted a flipped classroom and 27% had used open source material to augment course content. The majority of faculty said that they were familiar with tools of technology and social media but had not used them and felt they were not pertinent to their classes (FTI Consulting).
So what are the key messages from these two scenarios for nursing educators about the need for innovation and change in nursing education? What challenges and opportunities should educators consider related to using new tools of technology, revising instructional strategies, or upcycling some of the more familiar instructional strategies? How do educators select from the palette of tools and strategies that are currently available (or have been available from the past)? How can educators successfully implement these tools and strategies into current and future teaching spaces to support student learning? What pedagogical criteria should drive the selection of tools and approaches?
This paper explores the need for resetting nursing education and discusses the impact and implications of reviewing nursing education’s vision, focusing on students’ needs, incorporating technology into teaching and learning spaces, and connecting the capacities of current students with new instructional strategies. Resetting nursing education needs to demonstrate a significant difference in formative and summative learning from both faculty and student perspectives.
A reset changes or transforms a current vision or view of the world and makes fundamental changes in the machinery (processes and resources) of organizations. It enable individuals to respond to differences, issues, and challenges within the educational environment (Mootee, 2015). Resetting is often associated with starting over again and, in nursing education, it often refers to technological disruption, changing pedagogy, innovative insights, or transformation (Bassendowski & Petrucka, 2015; Mitchell et al., 2016).
Undergraduate and graduate nursing classrooms are evolving in response to shifts in student values and attitudes, along with changes in faculty beliefs about the pedagogical significance of instructional strategies. The diversity and information age mindset of today’s students have led many educators to critically reflect on ways to enhance the teaching and learning process and change the context in which students learn because “...for disruptive innovations to flourish, they must be packaged in a way that delights customers” (Christensen, Aaron, & Clark, 2003, p. 31). Educators are busy with curriculum design and delivery and sometimes get overwhelmed with daily teaching schedules, course syllabi, student assessment, tools of technology, and course preparation. “Nevertheless, the main issue is, and will always be, the persons involved and what is least technological about humans—memory, thinking, emotion and empathy” (Paiva, Morais, Costa, & Pinheiro, 2016, Final thoughts, ¶2). Change is difficult and although nothing is guaranteed, moving successfully to a higher level of expertise in teaching is increased with effort and work. Gladwell (2008) makes this point in his book Outliers by stating thatto become truly proficient in any discipline, one must invest a minimum of 10,000 hours (Johnston-Jewell, 2015). It is more than just an investment of time, it is about the experience gained while putting in the hours. “It takes experience to appreciate the failures, and it takes the failures to gain experience that drives success” (p. 27).
Many educational institutions acknowledge the need to reset the present environment; a reset that encourages them to become responsive, relevant, and future oriented. Resets are about the speed of decision-making, action, feedback, response time, change of direction, and support for early adopters within the organization (Mootee, 2015). But the recipients of health care expect more than just speed, change of direction, and response time from the professionals who provide their care; nursing educators constantly seek responses to this public challenge. In 2016, post-secondary institutions are educating students for a palette of careers that probably do not exist at this point in time. They are educating students to use technology that is perhaps not available but may be in some state of design and evolution. They are educating students to think critically about health care issues and nursing challenges that are not yet identified. It is increasingly important that students leave higher education with the pedagogical and technological skills they will require in the workplace and educators need to embed e-learning throughout their studies (Khambhati, 2015; Laurillard as cited in King & Boyatt, 2016; Wheeler, 2013). “Part of the problem may be that traditional educational institutions weren’t designed for a fast-changing market where skills depreciate quickly. Universities weren’t designed to change curricula and introduce new classes at the pace required by changing industry requirements” (Yang, 2013, ¶3).
The resetting process can provide educators with options for encouraging students to devise their journeys within the context of a course assignment or project. It is all about the options and choices for adult learners. The literature around educational design and curricula suggests that customization of student experiences, imaginative possibilities, and innovative practice are helpful concepts to keep in mind when adapting new strategies and methods to enhance and support student learning (Allen, 2016; Bass, 2012; Kaya, Turan, & Aydın, 2016; King & Boyatt, 2015; Stanley & Dougherty, 2010). In some ways, the giant Lego pieces that children play with can provide an analogy for educators to think about when building their courses. Consider the building blocks of a required course within an approved curriculum such as intents, goals, objectives, content, resources, references, policies, assessments, schedules, due dates, faculty information, examinations, technology, groups, expectations, assignments, academic integrity, papers, tests, and others. At first glance, it seems that the components of the list could be put together in a random fashion and still meet the teaching and learning goals of the course. But educators make decisions about how to build their courses and how to teach based on their expertise, experience, and view of the best ways to help learners acquire knowledge, skills, and attitudes (Bates, 2014). What tools are critical to support the delivery of essential content? What technology and social media apps should students use to support their own learning and/or co-learning? Where will these new paths in teaching lead faculty and students? What content and percentage of time is committed to lectures in comparison to other methods?
The initial concept of disruptive innovation in higher educational learning began with Christensen’s theory of disruption (Christensen, Aaron, & Clark, 2003). Christensen’s theory of disruption provides researchers and policy makers with an alternative perspective with which to view more accessible and newly emerging technologies and innovations in any setting. Bass (2012) uses the term “disrupting ourselves” to advance an argument that the key source of disruption is generated by an individual’s own practices. In the educational context, disruptive pedagogies introduce new technologies into higher learning that vary significantly from the traditional teaching tools (Meyer, 2010). Terms that have been used interchangeably with disruptive pedagogy in the literature include disruptive innovation, disruptive technology, and pedagogical innovation (Stanley & Dougherty, 2010).
Historically, disruptive pedagogies were first aligned with the computer in the 1950s to, most recently, the creation of online learning tools such as learning management systems, mobile devices (tablets, laptops, phones, etc.) and social media such as blogs, wikis, Twitter, Facebook, and podcasts (Bassendowski & Petrucka, 2015; Meyer, 2010). The scenario from the beginning of this article suggests that despite the selection of new tools for teaching, the instructional strategies that educators have used in the past for teaching is what they will currently use (Meyer, 2010; Paiva, Morais, Costa, & Pinheiro, 2016; Wiemer, 2016). The lecture has tended to be the dominant instructional strategy in nursing education programs. In 1929, the Canadian Nurses Association and the Canadian Medical Association commissioned Dr. G. Weir to conduct a national study of nursing education and provide a report with recommendations of what could be done to improve the training of nurses. Weir (1932) asked the reader to consider this question: “Are these nineteenth-century methods of instruction applicable in a rapidly moving twentieth-century world?” (p. 317). Weir discussed the need for educators to establish a connection with students during the presentation of content. He recommended that the lecture method in training schools for nurses should be reduced by at least two-thirds (p. 339). Nursing students and graduates have always been encouraged to identify health and illness patterns, research client data, and synthesize this information for better health outcomes (Stanhope & Lancaster, 2015). These experiences teach them how to accumulate, analyze, and select relevant data to safely provide or improve client care (Mawhirter & Garofalo, 2016). Yet, the implications of these approaches often are contrary to how contemporary students have learned about making choices - for example, think about the buttons on PlayStations or X-Boxes that they use to wipe the slate clean and start over. If they miss something, make a poor choice, or kill the character, instead of dealing with the consequences, they have the option to destroy all record of the errors and RESET back to an earlier, known place. They can go back and challenge the game again with the new knowledge of what they had done wrong the first time in hopes of having better fortune with a new, divergent path (de-Marcos, Garcia-Lopez, & Garcia-Cabot, 2016; Mawhirter & Garofalo, 2016). Similar to experiencing parallel universes, each time students push the reset button on the screen, they branch off to other possibilities in the game!
How do nursing educators capitalize on this aspect of learning? Students live and experience ubiquitous technologies in every moment of their lives: The Internet of everything. Sensors everywhere. Mobile devices. Clouds. Drones. Social media. Apps. 3D printing. Augmented reality. Virtual time. Students can access just about anything and everything — with amounts of information beyond the point of understanding or comprehending. Where is the link? Perhaps interprofessional health care simulation is part of the answer to working with these generations of students to enable resettingand move forward again (and again). But what about other strategies for resetting nursing education? How can educators upcycle traditional instructional strategies to provide fresh, updated approaches to support student learning?
Upcycling Instructional Strategies
McDonough and Braungart’s (2013) book, The Upcycle: Beyond Sustainability — Designing for Abundance focuses on the question, “What’s next?” for the products and processes that society creates over time. The authors challenge readers to not only create products that will be useful for what they are intended but to think about how to design them to be useful again and again and perhaps in a different context. The authors suggest that individuals need to question things that have long been accepted as facts and explore options that may seem unrealistic at first glance. So what about nursing education? How can educators design and redesign strategies and tools for teaching that will have a difference purpose for a different context? The following example describes an upcycled instructional strategy based on a children’s series of books and redesigned for undergraduate nursing students.
During the late 1970s to the 1990s, one of the most popular children’s series was the Choose Your Own Adventure created by Packard (n.d). Each story was written in the second person with the reader making choices that determined the main character's actions and the plot's outcome. The stories were written so that after a couple of pages of reading, the child faced two or three options, each of which presented additional options and then directed him/her to one of many endings. This allowed for a sense of unpredictability and the possibility of repeat readings which was one of the distinguishing features of the books.
The authors of this article used the concepts of “unpredictability and options” to design the Choose Your Own Nursing Adventure template for undergraduate nursing students. The initial template uses content related to ethics, infection control, and selection of options for safe client care. The template acknowledges the importance of both critical thinking and disruptive technology as the foundation for the pedagogy supporting the creation of the online template for student learning and engagement. Students are encouraged to solve challenges, explore options, and reflect on what they are learning. In turn, they can relate these experiences to the knowledge or perspectives they already have, create more knowledge, or reflect on what they need to do in specific situations.
The Choose Your Own Nursing Adventure requires students to become engaged in the learning process, either individually or in pairs, as it unfolds and supports analysis of specific health care and ethical situations, choices, and circumstances. This strategy encourages post-secondary students to use their critical thinking and intuition along with classroom content to be successful in completing the learning challenges. In addition, links to additional content or organizational sites are added for those students who want to review course content to make evidence-informed decisions about the situations. The template is designed for an easy replacement of course content, concepts, visuals, and comprehension questions. The Choose Your Own Nursing Adventure is an example of an upcycled approach for nursing students.
Faculty should consider resetting nursing education from the perspective of pedagogical significance, critical thinking, thought processes, and nursing challenges. Educators need to reflect on the impact and implications of incorporating technology into their teaching and learning spaces before using the tools of technology just for the sake of using technology. They need to be thoughtful about choices and proceed through the disruptive process with a clearly determined pathway and not just proceed by chance. Technology is not pulling educators away from the traditional values of teaching, “…rather it is reminding them of their authentic selves – expansive, interconnected, and with limitless creative potential” (Bilous, 2015, ¶7).
The tools of technology need to support student learning outcomes and demonstrate a difference from both faculty and student perspectives. There are opportunities and challenges when using technology within a teaching context, but faculty commitment and a belief that technology contributes to change are essential for success. The question Weir raised in 1932 can be reset for today: Are 20th-century methods of instruction applicable in a rapidly moving, 21st-century world? Overall, resetting nursing education has the potential to make a difference in the relationships of students, educators, and clients and focus on improvements in health care outcomes.
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Sandra Bassendowski, EdD, RN
Dr. Bassendowski is a Professor with the College of Nursing, University of Saskatchewan, Regina campus. Her research focuses on the scholarship of teaching and learning and the integration of technology in educational spaces. She has conducted research and evaluation for educational programs in countries such as the Philippines, India, Panama, and Nepal and in the Caribbean. She is currently exploring the implications of augmented reality for nursing education.
Pammla Petrucka, RN, PhD
Dr. Pammla Petrucka is a Professor with the College of Nursing, University of Saskatchewan. Her research focuses on vulnerable populations, communities, information communications technology, and women’s health.