John Hattie & Visible Learning

Journal Club Article: Hattie, J. (2008). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. Routledge [sample].


Aimed “to synthesize over 800 meta-analyses about the influences on achievement to present a more global perspective on what are and what are not key influences on achievement” (Hattie, 2008). Hattie found 138 influences of learning from the synthesis of over 800 meta-analyses.

Big Data in Education

Hattie is bringing big data into the field of education. Using the meta-analysis approach of healthcare, like Cochrane and combining the research to provide a dataset with more impact.

Visible Learning, Visible Teaching

According to Hattie, learning is the explicit goal and this occurs when feedback is given, active participation from student and teacher, learning strategies are provided, development of self-regulatory attributes and the student becomes the teacher. Teachers see learning though the eyes of the student and aid them to become the students to become their own teachers. The teacher role becomes one of support, guidance and instruction and knowing when support is required. When all this occurs in teaching we have:

  1. Visible Learning
  2. Visible Teaching

The 2 infographics summarise the work of John Hattie very succinctly. The question for the nurse educator is to work out what relevant from Hattie’s work that can be transferred from the school setting (pedagogy) into adult learning (andragogy).

Areas Relevant For Nurse Education

Like any education research from the school setting it must be considered if this is relevant and transferable to the adult and workplace education setting. But it’s always good to visit new and different ways to deliver education.

  • Piaget’s cognitive development theory and learning how to learn.
  • Providing meaningful and regular feedback.
  • Use of formative assessment to gauge learning progress.
  • Micro-teaching- small group work with engagement and discussions.
  • Discussions on important issues.
  • Teacher clarity.
Visual Learning Infographics

Video Resources


Hattie, J. (2012). Visible learning for teachers: Maximizing impact on learning. Routledge.

Hattie, J. (2008). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. Routledge [sample].

Developing Person-Centred Care: Addressing Contextual Challenges Through Practice Development

Journal Club Article: McCormack, B., Dewing, J., & McCance, T. (2011). Developing person-centred care: addressing contextual challenges through practice development. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 3.

This article aims to identify and discuss issues to consider in the development of person-centred care. As healthcare moves into service deliver for the individual then the focus of person-centred care will become increasingly important in training nurses of the future and current ones to deliver care on an individual level.

What is Person-Centred Care?

McCormack et al. (2011) define person-centred care as “an approach to practice that is established through the formation and fostering of therapeutic relationships between all care providers, patients, and others significant to them.”

How to Deliver Person-Centred Care?

“Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of developments, a commitment both in clinical teams and across organizations.”

  • Practice context,
  • Workplace culture,
  • Learning culture,
  • Physical environment.

The authors suggest in healthcare there are ‘person-centred moments’, at the individual level with ad hoc experiences of person-centredness occurring but not at a sustained and meaningful level.

“…it must further be considered how person-centred moments can be transformed into ‘person-centred cultures’ of practice…”


“The international drive (particularly over the past 15 years) to ‘modernise’ healthcare systems has led to a significant focus on the impact of culture on the clinical effectiveness of staff and service-user experiences of health and social care. Cultures are also characterised by shared values, team effectiveness, a commitment to continuous learning and improvement, and transformational leadership.”

“The key goal in the development of a positive learning culture is to recognize and overcome individual, group, and organizational barriers in order to move towards an effective culture and to overcome the features of workplaces that nurture hierarchical management and horizontal violence (Brown & McCormack, 2011).”

Person-centred care must underpin culture of teams and organisations. This requires empowerment and emancipatory practice to occur throughout the organisation. The traditional hierarchy and autocratic practice will need to be addressed to create an organisational change.

Contextual Factors and the Development of Person-Centred Care

The authors ask us to consider the shifts when it all worked, it clicked into place and the team worked. Admission, discharges, post ops, deterioration, family updates, all staff were well supported and you finished with a buzz and achievement that you expected nursing to on a regular basis. Positive thoughts here, hopefully you can recollect one shift in recent times (even you UK NHS staff).

Why can’t it be like this all the time?

This is the question we need to ask and reflect on. What was it about this shift that made it all work and how can we replicate this. So for person-centred care the focus is not just on the client but also the healthcare team. If they cannot perform to their best, then the service will not excel.

The authors recognise and “acknowledge that we do not work in a state of utopia, and that everyday practice is challenging, often stressful, sometimes chaotic, and largely unpredictable”. So some days will just be awful, sad and depressing but if we can make them fewer then surely staff satisfaction, teamwork, burnout and other stressors could be reduced.

Education focus: Active Learning 

A learning culture is a culture in which nurses view their work as exciting and revitalising, offering them the prospect for both personal and professional growth.

“Active learning draws on many activities including multiple intelligence’s, critical reflection, learning from self, and also conversations and shared experiences with others, all of which enable facilitation of change in the workplace. Central to active learning is both the translation of learning into practice so that the practitioner’s own practice is experienced differently and the enabling or facilitating of active learning with others. Active learning takes knowledge, in its many forms, and looks at how it can become (emotionally) meaningful for individuals and teams.”

How do I move towards this way of nursing?

“Developing Person-Centred Care Through Emancipatory Practice Development Practice which emphasises the central place of learning through everyday practice, what we have come to describe as ‘active learning.”

The Environment

“the physical environment needs to work in concert with the cultural values in care teams and the ways of working that enable person-centredness to be realised. In this respect, two aspects of the physical environment need to be attended to, namely, the built environment and the aesthetic environment. Most hospitals and healthcare facilities have been designed and built with ‘clinical efficiency,’ and not personcentredness, in mind.”


In the development of a framework for person-centred nursing, McCormack and McCance (2010) identified a range of attributes of practice contexts that impacted on the operationalisation of person-centred care. Of particular significance were workplace culture, learning culture, and the physical environment. The health organisation needs to provide conditions that are necessary for staff to feel empowered.

Keywords: person-centred; emancipation; culture; active learning; transformational leadership.


McCormack, B., Dewing, J., & McCance, T. (2011). Developing person-centred care: addressing contextual challenges through practice development. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 3.






Paulo Freire and Critical Pedagogy

“To the oppressed, and to those who suffer with them and fight at their side” (Paulo Freire). 

Freire states that thinking educational practice and liberation are intertwined. Education can be humanistic and remove the shackles of the oppressed, by liberating themselves and the oppressors as well.

Education should not be divorced from politics and the act of teaching and learning are political components. The education process is therefore not a neutral process. Freire’s belief was to provide native populations with an education which was both new and modern (rather than traditional) and not simply an extension of the culture of the colonizer. Just look at World Bank and their “education for all policy’, all linking in with the International Monetary Fund (IMF) and UNESCO and using national qualification frameworks devised for the western world, is this what Freire would call ‘the colonizers”?

In education the freedom to say ‘why’. Remember when higher education was a place to question authority, broaden your knowledge and political convictions not just become a ‘work ready’ product of the education system.

No one is born fully-formed: it is through self-experience in the world that we become what we are.” (Paulo Freire)

Critical pedagogy

“Critical pedagogy is a philosophy of education and social movement that has developed and applied concepts from critical theory and related traditions to the field of education and the study of culture. Advocates of critical pedagogy view teaching as an inherently political act, reject the neutrality of knowledge, and insist that issues of social justice and democracy itself are not distinct from acts of teaching and learning. The goal of critical pedagogy is emancipation from oppression through an awakening of the critical consciousness, s a philosophy of education and social movement that has developed and applied concepts from critical theory and related traditions to the field of education and the study of culture” (Wikipedia, 2017).

Critical pedagogy  is a continuous process of:

  • unlearning,
  • learning,
  • and relearning,
  • reflection,
  • evaluation.

For Freire the goal of creating not only a better learning environment but also a better world is the focus. It’s interesting to read and reflect at where we are at today, as if you consider the world of higher education you could be forgiven in thinking that maybe the key focus of education in it’s ability to transform at a personal and society level has been forgotten in a business driven education system. Or is critical thinking alive and well and we are actually more aware of critical pedagogy and social movement due to the nature of connectivity and the internet?


To the oppressed, and to those who suffer with them and fight at their side” (Friere, 2000).

“Education thus becomes an act of depositing, in which the students are the depositories and the teacher is the depositor. Instead of communicating, the teacher issues communiques and makes deposits which the students patiently receive, memorize, and repeat. This is the “banking” concept of education, in which the scope of action allowed to the students extends only as far as receiving, filing, and storing the deposits” (Freire, 2000).

If the structure does not permit dialogue the structure must be changed.” (Paulo Freire)

“In the banking concept of education, knowledge is a gift bestowed by those who consider themselves knowledgeable upon those whom they consider to know nothing. Projecting an absolute ignorance onto others, a characteristic of the ideology)of oppression, negates education and knowledge as processes of inquiry”  (Freire, 2000).

The passive nature of “banking”in education according to Freire is the attempt to control students thinking and action, and inhibits the creative ideology of generations. This makes for a passive society. Get revolutionary people!

Keywords: critical pedagogy; banking; praxis; critical thinking; power; oppressed.


Freire, P. (2000). Pedagogy of the oppressed. Bloomsbury Publishing.

Freire Institute (2017) Paulo Freire.

Wikipedia (2017) Paulo Freire.

Rosemary For The Brain

Small studies but maybe worth a try to gain that extra boost come examination time even if this works out of expectation.

“A small, but growing body of research has been carried out to investigate the possible influence of the aromas of essential oils on cognition and mood in the healthy population. Given that the properties of aromas are to a great extent defined by folk wisdom rather than scientific evaluation, expectancy might be a reasonable candidate or at least a confounding variable worthy of addressing. A second potential mode of influence of aromas is the hedonic valence mechanism that describes the relationship between the pleasantness of an aroma, the associated effect on mood and the consequential impact on behaviour/performance.” (Moss & Oliver, 2012).

Population: 20

Objective: The study was designed to assess the potential pharmacological relationships between absorbed 1,8-cineole following exposure to rosemary aroma, cognitive performance and mood.

Methods: Mood assessments were made pre and post testing, and venous blood was sampled at the end of the session.

Results: Participants remember events that will occur in the future by 60-75 percent and to “remember to complete tasks at particular times.”

Conclusion: Moss & Oliver (2012) findings “suggest that compounds absorbed from rosemary aroma affect cognition and subjective state independently through different neurochemical pathways. With regard to the behavioural effects of exposure to rosemary essential oil aroma, the results reported here support previous work indicating that rosemary aroma can influence cognitive performance and mood.”



Coughlan, S. (2017). Exam revision students ‘should smell rosemary for memory’. BBC website.

Moss, M., & Oliver, L. (2012). Plasma 1, 8-cineole correlates with cognitive performance following exposure to rosemary essential oil aroma. Therapeutic advances in psychopharmacology, 2(3), 103-113.

Personal Best (PB) Setting & Perfectionism in Learning

This post’s focus is on personal best (PB), setting high standards and how to assist the perfectionist in learning.

Martin & Elliot (2016)

“In a climate of benchmarks, comparisons, accountability, and league tables, it is important to ensure that students are not excluded from access to academic success or denied a sense of academic progress (Anderman, Anderman, Yough, & Gimbert, 2010). Greater attention to individuals’ academic growth may provide a foundation for giving a wide range of students a better sense of their academic progress. PB goals are defined as specific, challenging, competitively self-referenced targets to which students strive to match or exceed a previous best.”

Need to understand the importance of ‘self-based goals’ as part of ones own intrapersonal trajectory and growth goals.

“Achievement goal theory is one perspective relevant to the study of PB goals. At a fundamental level, achievement goal theory is grounded in a distinction between mastery-approach goals focused on understanding, developing skill, or improvement, and performance-approach goals focused on outperforming others or demonstrating comparative competence (Elliot, 2005).”

“PB goals may energize students and, PB goals may create a discrepancy between current and desired attainment, a gap that students are motivated to close” (Martin, 2011).

PB goal setting can thus lead to gains in students’ educational aspirations.

Thuy-vy & Deci (2016)

Study explored a motivational approach to examining individuals’ perfectionistic strivings, using Self Determination Theory.

“Perfectionists are characterized as people who strive for extremely high standards, are obsessively concerned over making mistakes, experience constant self-doubts, tend to be overly organized, often experience high internalized parental expectations, and grow up facing a lot of parental criticisms. Among those components, the element that pertains to perfectionists’ tendency to set high personal standards has recently spurred debates among researchers, mainly around the question of whether setting high standards can be the positive aspect of perfectionism” (Thuy-vy & Deci, 2016).

Thuy-vy & Deci (2016) suggest there is “convergent evidence at both the between-person and the within-person, between-class levels that when students reported low controlled regulation, those who tended to set high standards for themselves reported less anxiety and difficulty in their learning, and more learning progress in their classes than the students who set low standards.”

Generally, high standard perfectionists are likely to internalize and identify with their standards to a certain extent, and those who set high standards were also likely to put more effort into their classes.

Thuy-vy & Deci suggest that “coaches, teachers, or counselors who work with high-standard perfectionists might usefully pay attention to how those perfectionists regulate behaviors intended to meet personal standard. Counseling approaches such as motivational interviewing or mindfulness training can also be used to help perfectionists become less controlled in attempting to attain their standards.”


Setting high standards leads to more mastery goals rather than seeking performance goals. Motivated students are more engaged in the class setting. The questions on perfectionism remain highly debatable in regards to the stress, anxiety, self perception and external motivators. So a balanced work-life approach to learning and development seems to be a healthier approach for motivation and avoiding burn out.

Keywords: perfectionist; self determination theory; motivation; personal best; PB.


Martin, A. J., & Elliot, A. J. (2016). The role of personal best (PB) goal setting in students’ academic achievement gains. Learning and Individual Differences, 45, 222-227.

Thuy-vy, T. N., & Deci, E. L. (2016). Can it be good to set the bar high? The role of motivational regulation in moderating the link from high standards to academic well-being. Learning and Individual Differences, 45, 245-251.

Ross, P. (2017) Intrinsic and extrinsic motivations by Ryan Deci. Nursing Education Network.

Nurse as educator: Principles of teaching and learning for nursing practice

Book Club: Bastable, S. (2014). Nurse as educator: Principles of teaching and learning for nursing practice (4th ed.). Burlington, MA: Jones & Bartlett Learning. [link to 2nd edition]

It’s good to return to the true literature (time depending) and read a holistic overview of nursing education. This USA flavored (flavoured) book covers a historical and contemporary view of the challenges facing educating nurses. The complex nature of today’s healthcare systems and transforming nursing education are discussed. Bastable also provides a reminder to retain the focus and importance of patient education not just solely educating nurses, to increase competence and confidence of clients to enable greater self-management.

Teaching & Learning of Nurses

“The education process is a systematic, sequential, logical, scientifically  based, planned course of action consisting of two major interdependent operations: teaching and learning” (pg. 13).

The two interdependent players in the learner and education and growth occurs in both parties. That the role of the educator is to promote learning and provide a conductive learning environment.

Relates the education process to the nursing process:

  • ascertain learning needs
  • develop a teaching plan
  • deliver teaching
  • determining behaviour, attitude or skill changes

That the actual act of teaching and instruction is one component of this education process.

Barriers to teaching and learning:

  • lack of time
  • lack of motivation and skills
  • negative environment
  • lack of confidence and competence

Motivation Factors:

  • personal attributes
  • environmental influences
  • relationship systems
  • state of anxiety
  • learner readiness
  • realistic goal setting
  • learner satisfaction and success

Also provides helpful guidance on motivational interviewing techniques.


Bastable, S. (2014). Nurse as educator: Principles of teaching and learning for nursing practice (4th ed.). Burlington, MA: Jones & Bartlett Learning. [link to 2nd edition]


Educating Nurses for the Future of Healthcare

Now I am using my speciality area of ICU as the focus article, but the themes will cross all areas of the hospital system looking into the future. So the question will be how education approaches the task of training the nurses of the future? Look at the themes of personalised medicine, telemedicine, more communication but less face to face time and we see an outline of healthcare in the year 2050.

Article: Vincent, J. L., Slutsky, A. S., & Gattinoni, L. (2016). Intensive care medicine in 2050: the future of ICU treatments. Intensive Care Med. DOI 10.1007/s00134-016-4556-4.

The hospital is definitely smaller than in the past with lots of ICU beds, but very few other beds. And, it looks more like a five-star hotel than a hospital, with nice shops and restaurants in the lobby—it makes you forget you’re in hospital.

Person-centred healthcare delivery is considered gold standard and what we strive to deliver, so making the environment match the service seems a sensible approach. One question we need to ask now is the generic nature of checklists, okay in an emergency situation to assist human factors but it may be time to stop looking at simplistic check lists as the complex multi system failure patient is here and so we need more complex systems to support these patients and artificial intelligence is ready to help.

A lot of the time the screen is blank, but it displays alarms when anything goes wrong and can show anything you want to see at the push of a button: trends in variables, all kinds of curves, laboratory results, X-rays, consultant’s notes, you name it. There’s also a really cool system that teaches me all about my medical condition and that can connect me with other patients who have similar medical issues. The computers that control this can somehow link me to patients around the world who have similar values, expectations, and concerns to mine.”

if you press the red button, a nurse immediately appears on the screen over any other data display, asking what you need or want!

Face to face and loss of the human touch but time critical responses to meet the needs of the patient, not when we can get there. It will be interesting for both nursing and medical staff how the role of telemedicine will impact on the professions and communication strategies. Remember robots may well be doing the hands on care in the hospital and in the home.

but now I’ve got a percutaneous sensor that measures almost every lab test. Everything seems to be non-invasive.

This is the critical thinking part, what will be needed in the future from the nurse is a response to the alert system, as artificial intelligence will provide risk scores and responses to the changes of each individual patients 24 hours a day. But will the nurse need to understand the changes and trends of the patients observations, or are these skills no longer required and other skills need to be developed? Don’t think about extended nurse roles such as line insertion or minor surgery, this is now completed by robots.

“the bed kept moving to assess how much fluid I needed while my cardiac response was monitored by the probes. There was even a closed-loop system driven by a computer that continued to deliver fluid challenges as long as my cardiac output was responsive, combining it with titration of vasopressors and inotropic agents.”

Closed-loop systems mean interventions will occur when actually needed from clinical data and in a timely response by automated systems. Is there any need for human interaction and training required here?

I’m also receiving extracorporeal lung/renal/metabolic support—this is an impressive system that, by passing my blood through an external system, oxygenates it and cleans it.”

What is ICU domain now, may well just become regular treatments in the future. And as society may expect more health longevity and technology delivers more, then maybe the hospital becomes an extension of the ICU. Every patient will be automatically monitored like a current ICU patient now anyhow.

They do quite a lot of surgical procedures here, but there are hardly any surgeons: all surgery is done remotely with surgeons only present in case of exceptional technical breakdown.

Again robots are leading the way. So what will the nurse and medic do in these circumstances, will it be one professional overseeing numerous procedures at multiple sites? Simulation training will be using robotics and virtual reality for an interactive and realistic training experience (high fidelity rules for the simulation purists).

Worried it all becomes a little impersonal? don’t worry……

You might think this all sounds a bit inhuman, but it’s not at all. Although there are fewer doctors doing procedures and interventions, the ones that are present are much more available to talk to you, to explain, answer questions, and reassure me and my family.

Research: big data rules.

they have this huge database of all the patients’ results and outcomes for the past 25 years, so that they can see if anyone else had the weird syndrome I had, and then figure out the best way to treat it.”

So the question remains on how we approach education to train the nurse of the future, will it be humans or robots? Maybe the nurse educator needs to put coding near the top of the skills list.

Keywords: robotics, virtual reality, artificial intelligence, robots, telemedicine, nurse training; person-centred care.


Vincent, J. L., Slutsky, A. S., & Gattinoni, L. (2016). Intensive care medicine in 2050: the future of ICU treatments. Intensive Care Med. DOI 10.1007/s00134-016-4556-4

Mesko, B. (2017) The Medical Futurist (TMF).