Novice To Expert: Constructivism in Nursing

Novice to Expert

Working under stress requires the ability to prioritise, multi-task, advocate, maintain effective time management and is part of a suite of learning skills considered ‘novice to expert’ in nursing (Benner, 1982). This ability to transfer thoughts and process information, which are relevant to the particular situation, time and place, is of utmost importance for effective decision-making. Moreover, Jean Piaget’s theory of cognitive development states that thoughts, memory, past experience, problem solving, and processing information all influence the learner.

Piaget’s concept of schema theory involves the organized structure of memories, past experience and the knowledge we possess and develop over time. Constant interpretation is considered the process of adaptation and assimilation to the environment. Cognitive processes of types of knowledge, using the taxonomy of Krathwohl (2002) are utilized in the work environment by educators to engage and develop the learner in high-level engagement. Assimilation is using new experiences to already existing schema, knowledge and experiences. This constant building of experience on experience is the scaffolding of learning in nursing. It can take years to build experience on top of knowledge to scaffold performance on the novice to expert pathway.

Clinical shifts regularly provide feedback opportunities through clinical supervision, along with performance management plans. This feedback practice must align with the nursing students learning objectives. For nurse mentors or peer support, the development of constructive feedback methods is essential as part of clinical supervision. Reflection is a major component of development and learning, and applying frameworks, such as Gibbs (1988) and Johns (2009), for reflective processes in nursing can help make sense of experiences and summarize events.

Frameworks

Using Benner (1984) “novice to expert” or Bondy (1983) “dependent to independent” frameworks to create the learning environment can help align content to nursing experience or skills expected to be learnt and assessed (see Intended Learning Outcomes).

Curriculum development from setting intended learning outcomes, subject content and assessments can be aided by the use of Bloom’s Taxonomy to align and scaffold education delivery . This can help provide focus for the delivery of education and meeting educational objectives.

References

Benner, P. (2004) Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education. Bulletin of Science, Technology & Society June 2004 24: 188-199.

Benner, P. (1984). From novice to expert. Menlo Park.

Bondy, K, N. (1983). Criterion-referenced definitions for rating scales in clinical evaluation. Journal of Nursing Education. Vol. 22, no. 9, pp. 376-382.

Krathwohl, D. R. (2002). A revision of Bloom’s taxonomy: An overviewTheory into practice, 41(4), 212-218.

Iowa State University. (2016). Revised Blooms Taxonomy. Center for Excellence Learning & Teaching.

Nursing Education Network. (2017). Blooms Taxonomy & Constructivism.

Good and Bad Studying by Barbara Oakley

These rules form a synthesis of some of the main ideas of the course–they are excerpted from the book A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra), by Barbara Oakley, Penguin, July, 2014.

10 Rules of Good Studying

  1. Use recall. After you read a page, look away and recall the main ideas. Highlight very little, and never highlight anything you haven’t put in your mind first by recalling. Try recalling main ideas when you are walking to class or in a different room from where you originally learned it. An ability to recall—to generate the ideas from inside yourself—is one of the key indicators of good learning.
  2. Test yourself. On everything. All the time. Flash cards are your friend.
  3. Chunk your problems. Chunking is understanding and practicing with a problem solution so that it can all come to mind in a flash. After you solve a problem, rehearse it. Make sure you can solve it cold—every step. Pretend it’s a song and learn to play it over and over again in your mind, so the information combines into one smooth chunk you can pull up whenever you want.
  4. Space your repetition. Spread out your learning in any subject a little every day, just like an athlete. Your brain is like a muscle—it can handle only a limited amount of exercise on one subject at a time.
  5. Alternate different problem-solving techniques during your practice. Never practice too long at any one session using only one problem-solving technique—after a while, you are just mimicking what you did on the previous problem. Mix it up and work on different types of problems. This teaches you both how and when to use a technique. (Books generally are not set up this way, so you’ll need to do this on your own.) After every assignment and test, go over your errors, make sure you understand why you made them, and then rework your solutions. To study most effectively, handwrite (don’t type) a problem on one side of a flash card and the solution on the other. (Handwriting builds stronger neural structures in memory than typing.) You might also photograph the card if you want to load it into a study app on your smartphone. Quiz yourself randomly on different types of problems. Another way to do this is to randomly flip through your book, pick out a problem, and see whether you can solve it cold.
  6. Take breaks. It is common to be unable to solve problems or figure out concepts in math or science the first time you encounter them. This is why a little study every day is much better than a lot of studying all at once. When you get frustrated with a math or science problem, take a break so that another part of your mind can take over and work in the background.
  7. Use explanatory questioning and simple analogies. Whenever you are struggling with a concept, think to yourself, How can I explain this so that a ten-year-old could understand it? Using an analogy really helps, like saying that the flow of electricity is like the flow of water. Don’t just think your explanation—say it out loud or put it in writing. The additional effort of speaking and writing allows you to more deeply encode (that is, convert into neural memory structures) what you are learning.
  8. Focus. Turn off all interrupting beeps and alarms on your phone and computer, and then turn on a timer for twenty-five minutes. Focus intently for those twenty-five minutes and try to work as diligently as you can. After the timer goes off, give yourself a small, fun reward. A few of these sessions in a day can really move your studies forward. Try to set up times and places where studying—not glancing at your computer or phone—is just something you naturally do.
  9. Eat your frogs first. Do the hardest thing earliest in the day, when you are fresh.
  10. Make a mental contrast. Imagine where you’ve come from and contrast that with the dream of where your studies will take you. Post a picture or words in your workspace to remind you of your dream. Look at that when you find your motivation lagging. This work will pay off both for you and those you love!

10 Rules of Bad Studying

Excerpted from A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra), by Barbara Oakley, Penguin, July, 2014

Avoid these techniques—they can waste your time even while they fool you into thinking you’re learning!

  1. Passive rereading—sitting passively and running your eyes back over a page. Unless you can prove that the material is moving into your brain by recalling the main ideas without looking at the page, rereading is a waste of time.
  2. Letting highlights overwhelm you. Highlighting your text can fool your mind into thinking you are putting something in your brain, when all you’re really doing is moving your hand. A little highlighting here and there is okay—sometimes it can be helpful in flagging important points. But if you are using highlighting as a memory tool, make sure that what you mark is also going into your brain.
  3. Merely glancing at a problem’s solution and thinking you know how to do it. This is one of the worst errors students make while studying. You need to be able to solve a problem step-by-step, without looking at the solution.
  4. Waiting until the last minute to study. Would you cram at the last minute if you were practicing for a track meet? Your brain is like a muscle—it can handle only a limited amount of exercise on one subject at a time.
  5. Repeatedly solving problems of the same type that you already know how to solve. If you just sit around solving similar problems during your practice, you’re not actually preparing for a test—it’s like preparing for a big basketball game by just practicing your dribbling.
  6. Letting study sessions with friends turn into chat sessions. Checking your problem solving with friends, and quizzing one another on what you know, can make learning more enjoyable, expose flaws in your thinking, and deepen your learning. But if your joint study sessions turn to fun before the work is done, you’re wasting your time and should find another study group.
  7. Neglecting to read the textbook before you start working problems. Would you dive into a pool before you knew how to swim? The textbook is your swimming instructor—it guides you toward the answers. You will flounder and waste your time if you don’t bother to read it. Before you begin to read, however, take a quick glance over the chapter or section to get a sense of what it’s about.
  8. Not checking with your instructors or classmates to clear up points of confusion. Professors are used to lost students coming in for guidance—it’s our job to help you. The students we worry about are the ones who don’t come in. Don’t be one of those students.
  9. Thinking you can learn deeply when you are being constantly distracted. Every tiny pull toward an instant message or conversation means you have less brain power to devote to learning. Every tug of interrupted attention pulls out tiny neural roots before they can grow.
  10. Not getting enough sleep. Your brain pieces together problem-solving techniques when you sleep, and it also practices and repeats whatever you put in mind before you go to sleep. Prolonged fatigue allows toxins to build up in the brain that disrupt the neural connections you need to think quickly and well. If you don’t get a good sleep before a test, NOTHING ELSE YOU HAVE DONE WILL MATTER.

Reference

Oakley, B. (2014) A Mind for Numbers: How to Excel in Math and Science (Even if You Flunked Algebra). Penguin. [Goodreads blurb]

Additional Learning Resources

Why We Became Nurse Educators (Journal Club)

Journal Club Article: Evans, J. D. (2018). Why We Became Nurse Educators: Findings From a Nationwide Survey of Current Nurse Educators. Nursing Education Perspectives39(2), 61-65. [abstract]

Background: The need to build the nurse faculty workforce and resolve the persistent shortage of educators led to a study of nurse educator recruitment and retention. The shortage of nurse educators is a barrier to building the nursing workforce.

Aim: The study was designed to ask teaching nurse faculty what they believed would be effective strategies in the attraction, recruitment, and retention of nurse educators through a sample of national nurse faculty.

Method: This descriptive study used an online survey questionnaire. Participants were recruited through email requests to the deans and directors of 841 accredited associate (ADN), baccalaureate (BSN), master’s, and doctoral degree programs at schools and colleges of nursing across the United States. 940 nurse educators teaching at all levels were asked to rate the effectiveness of attraction, recruitment, and retention strategies.

The survey consisted of demographic questions and three Likert type scales that asked respondents to rate the effectiveness of attraction, recruitment, and retention strategies. Open-ended questions in each section allowed participants to expand on their answers.

This article reports on responses to one of the survey’s open-ended question; a content analysis was conducted to develop a narrative description about why respondents chose nursing education.

Results: Nurse educator’s chose education roles to:

  • teach in a stimulating yet flexible work environment,
  • hoped to influence the profession,
  • had been influenced by educators, and
  • sought change and challenge in their careers.

Conclusion: “Faculty find nursing academia satisfying and rewarding, but noncompetitive compensation and unsatisfactory work environments can eclipse satisfiers.”

Keywords: Healthy Workplace; Nurse Faculty Recruitment; Nurse Faculty Retention; Nurse Faculty Shortage; Nursing Education; Workforce.

FORTH Innovation Method

Methodology of  innovation process to introduce and develop changes in ideas, business and products. 5 steps are taken in a stage-gated process.

  1. Full Steam Ahead
  2. Observe & Learn
  3. Raise Ideas
  4. Test Ideas
  5. Homecoming

Alleged success of the FORTH method are that out of 100 ideas, 78 are taken into development and 51 are introduced, compared to 21 in an average stage-gated process.

Resources

Forth Innovation Method.

Forth Innovation [Free downloads]

Van Wulfen, G. (2013). The Innovation Expedition: A visual toolkit to start innovation. Bis.

Follow Gijs van Wulfen @gijsvanwulfen

Playlists: Multimedia Production Part 4

Create a Video Playlist

You may be uploading and creating your own video playlist, or collating a playlist of useful resources to suit a particular topic. Here are some resources to consider using. Please post in the comments section any other resources that are available.

  • Viewer playlists – organise your favourite videos and share. No creation of videos is required, you are just grouping together useful resources to share.
  • Creator playlists – if you create videos it provides a way to organise videos into topics and for viewers to find them.
  • Organised into subject content, theme or whatever you choose.
  • Videos are organised in a legal format for yourself and others to view.
  • Can embed into a website or resource.
  • Can provide analytics.

Example: Nursing Education Network Playlist

How To Make A YouTube Playlist

Why To Make a YouTube Playlist

Some Persuasive Data from YouTube Statistics:

  • YouTube has over a billion users — almost one-third of all people on the Internet — and every day people watch hundreds of millions of hours on YouTube and generate billions of views.
  • YouTube overall, and even YouTube on mobile alone, reaches more 18-34 and 18-49 year-olds than any cable network in the U.S.
  • Growth in watch time on YouTube has accelerated and is up at least 50% year over year for three straight years.

Data from YouTube Statistics

Other video player resources: Vimeo or Apple.

Teaching And Learning Through Video 

Multimedia Posts

Recording: Multimedia Production Part 3

Use you mobile phone, laptop or tablet for quality video recordings. Just check your device to see what video recording and editing software you already have. There are lots of options available for editing but as a beginner using your devices editing software or using YouTube may be the easier and less frustrating approach until you build up your recording skills.

Some considerations:

  • Lighting
  • Stability (use two hands or a selfie stick)
  • Audio and background noise
  • Point of view: where is the camera focused on
  • Framing: orientation of the camera
  • Clean your lens

Inclusivity

Don’t forget to add captions and subtitles [more info here].

Multimedia Posts

Storyboard: Multimedia Production Part 2

Storyboarding

 “A storyboard is a graphic organizer in the form of illustrations or images displayed in sequence for the purpose of pre-visualizing a motion picture, animation, motion graphic or interactive media sequence” (Wikipedia, 2019).

Example of a Storyboard

Storyboard for The Radio Adventures of Dr. Floyd

Storyboard Resources

ACMI. (2019). Storyboarding for the beginner.

ACMI. (2019). Storyboard Template.

Classic Disney Animation

Editing Resources

IT skills and budget are likely key factors in finding suitable editing resources. Here are a few, but a quick internet search will show many available resources. 

Inclusivity 

Don’t forget to review accessibility during the creation of resources for neurodiversity inclusiveness.

Multimedia Posts

 

 

Multimedia Production: Part 1

This is the first post in the journey for development in multimedia production. I have minimal experience in photography or video production and so this is also a personal learning project. Any useful resources will be shared to enable nurse educators to give it a try themselves (anyone with multimedia experience please add resources in the comments section below). A ‘traditional’ nurse educator approach will be used (i.e. no budget), so whatever resources we already have or can borrow will be used.

  1. First step will be the process of multimedia production.
  2. Step two will be the production side of things.
  3. Step three the equipment, likely using a mobile phone and any free developing apps and potentially a borrowed GoPro.
  4. Step 4 creating and collating playlists

Video 101: Shooting Basics from Vimeo Video School

Rule of Thirds

“The guideline proposes that an image should be imagined as divided into nine equal parts by two equally spaced horizontal lines and two equally spaced vertical lines, and that important compositional elements should be placed along these lines or their intersections (Wikipedia, 2019).

Rivertree thirds md
Image by Moondigger [CC BY-SA 2.5] from Wikimedia Commons

Dialogue: The Art of Thinking Together

Book Club: Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

This book was suggested as part of preparation for participating in an Unconference. The purpose for this resource was to maximise the limited time, within a group of people with an interest in education but who were not known to each other, so to enable conversation and dialogue to occur in the one day timeframe. 

Dialogue is about “shared inquiry, a way of thinking and reflecting together”(pg. 9). 

This inquiry can involve telling stories and the ability to think and talk together. How we think does affect how we talk, with relation to our held memory and emotions.

“Dialogue is a practice for deliberately and consciously evoking powerful conversations like these” (pg 70).

The aim is to create mutual respect, coordination and connection within a group of people.  

  1. Listening
  2. Respecting
  3. Suspending
  4. Voicing 

Why is this important, well dialogue occurs in all walks of life. This approach can be used to work together, resolve conflicts (be warned this is not an easy process, the book provides many examples of dialogic discussion) and solve problems. The aim is to empower and create new ways of thinking and working together.

3 Levels of action in a dialogue (pg. 29-30):

  1. Produce coherent actions: do what we say,
  2. Create fluid structures of interaction,
  3. Provide an environment for dialogue to occur.

Path to Dialogue

Purpose of Dialogue

  • determine what is the problem?
  • In the world of information overload, dialogue can determine what truly matters to us?
  • Build capacity for new behaviour.
  • Learn to inquire together.

4 Principles of Dialogue

  1. Participation
  2. Unfolding
  3. Awareness
  4. Coherence

Learn to Listen

  • Prepare to listen
  • Learn to be present
  • What are you thinking?
  • Use reflective listening, see how others are experiencing the situation
  • Listen together

Listening Together

  • Respecting boundaries, but not being passive
  • Wholeness of the conversation
  • Awareness, the ability to suspend directions/opinions using reflection in action
  • Foster enquiry
  • Voice

The Environment

  • The container: for a rich field of interaction
  • Psychological safety

Keywords: Dialogue; Dialogic: Listening; Respect; Voice; Change Management

References

Argyris, C. (1977). Double loop learning in organizationsHarvard business review55(5), 115-125.

Argyris, C., & Schon, D. A. (1974). Theory in practice: Increasing professional effectiveness. Jossey-Bass.

Bohm, D., & Peat, F. D. (2010). Science, order and creativity. Routledge.

Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

Isaacs, W. N. (1993). Taking flight: Dialogue, collective thinking, and organizational learningOrganizational dynamics22(2), 24-39.

Yacavone, M. (2010). A Summary of… David Kantor’s Four-Player Model of Communication.

Clinical Supervision in Nursing

Instructional

Across nursing and healthcare, the supervision of students is an important component of training and learning. Clinical placements and the experiential learning experience are essential for developing and applying learned theoretical knowledge in the clinical environment. Undergraduate, graduate, postgraduate and new staff are all some of the unique supervision opportunities for nurses to support. Not every nurse will be interested in formal education, but it is likely they will be a preceptor or supervisor. Therefore it is important nurses understand the skills required for effective supervision. Skills such as reflective practice, assessment and feedback are part of this supervision. Being made to feel welcome and recognised as an important part of the team, just basic socialisation aspects to the nursing team.

Supervision

Supervision is defined “as a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, and is acknowledged to be a life-long process” (Martin, Copley, & Tyack, 2014, p. 201).

“Clinical Supervision is regular, protected time for facilitated, in-depth reflection on clinical practice” (Bond and Holland,1998 p. 12)

Models of Supervision

Proctor’s model of supervision is perhaps the most commonly used within health care. “Supervision towards reflective practice” (Proctor, 2010). Proctor’s framework focuses on 3 areas of supervision:

  1. Normative: managerial aspect of practice and learning, such as professional CPD and core mandatory training.
  2. Formative: educative aspect of developing knowledge and skills in professional development and use self reflection for self awareness development. The aim is “to become increasingly reflective upon practice” within the supervision process (Proctor 2001, p.31).
  3. Restorative: supportive aspect for personal development, improving stress management and burnout prevention.

Clinical Supervision Skills Review Tool 

This Clinical Supervision Skills Review Tool is a helpful resource to review your supervision skills. More about this resource in the video below.

Other resources:

Note: This blog post resources and notes were taken from attending an education session ran by Monash University on supervision.

References

Boud, D., & Molloy, E. (2013). Rethinking models of feedback for learning: the challenge of designAssessment & Evaluation in Higher Education38(6), 698-712.

Carrucan-Wood, L. (2015). Preceptorship: Grounding and growing the next generation. Nursing Review.

Department of Health and Human Services. (2015) Clinical Supervision Skills Review Tool.  Victorian Government, Melbourne.

Hattie, J., & Timperley, H. (2007). The power of feedbackReview of educational research77(1), 81-112.

Martin, P., Copley, J., & Tyack, Z. (2014). Twelve tips for effective clinical supervision based on a narrative literature review and expert opinionMedical teacher36(3), 201-207.

Proctor, B. (2010). Training for the supervision alliance: Attitude, Skills and Intention. In Routledge handbook of clinical supervision (pp. 51-62). Routledge.

Sloan, G., & Watson, H. (2002). Clinical supervision models for nursing: structure, research and limitationsNursing Standard (through 2013)17(4), 41.

Winstanley, J. (2000). Manchester clinical supervision scale. Nursing Standard (through 2013)14(19), 31.