Create a Constructivist Online Learning Environment

Constructivist Learning Environments

Bloom taxonomy

In a constructivist learning environment, the educator needs to allow the learner to develop and learn, ideally allowing progression suited to the individual. The content will have to be incorporated into lesson plans and intended learning outcomes to scaffold learning. Integrating varied theoretical approaches to assist and encourage learning is key. The facilitator will need to be comfortable and confident in providing an environment that encourages active learning. If the educator is confident enough then a heutogogy based learning environment could be created, especially in an online learning approach.

Constructivist Online Course

  • E-learning would be planned to deliver a step by step program of the course topics.
  • At the interface level for the student, developing an engaging learning community to share ideas and create discussion.
  • To create an experimental environment, an online community would require rules of engagement, such as privacy and respect.
  • A positive and safe environment to encourage learning and seek challenges. Mistakes are welcome.
  • To build an experience, then encourage active engagement through discussion forums and online posting. The facilitator will need to know when to contribute or step back during discussions to allow open discussion.
  • Online lectures or recordings must have the ability for discussion and question to make collaboration possible.
  • Low stakes quizzes and tasks to create skills based assessment at certain stages through the course. Relate to real life situation, such as a workplace scenario to encourage active engagement and problem solving skills. Not all questions to have yes/no answers, allow multiple options to create different perspectives and rationales.
  • Create new ideas and receive feedback from learners.
  • Provide tips and advice of how to learn and study.
  • Use of reflective practice to encourage self-management and own learning development on a journey of lifelong learning,
  • Teach to learn, not just aiming to pass the test or the final numbers.

Nursing Constructivist Framework

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.

IT Platform

With so many learning management platforms available I will leave it up to Wikipedia’s explanation on learning management system. Some aspects to consider are the accessibility (is the information so important that really warrants a password?), the interface with mobile devices and the connectivity with social media and other platforms we use in our connected lives. Maybe consider the website model of open access and Wikipedia, Wikischools or Wikiversity.


Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.

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.

Huang, H. M. (2002). Toward constructivism for adult learners in online learning environments. British Journal of Educational Technology, 33(1), 27-37.

Koohang, A., Riley, L., Smith, T., & Schreurs, J. (2009). E-learning and constructivism: From theory to application. Interdisciplinary Journal of E-Learning and Learning Objects

The University of Sydney (2016) Constructivism

Wikipedia (2016) Learning Management System


Digital Badges

Learning now happens everywhere, so how can we recognise this learning? One option is to receive digital badges for completion of learning tasks. Earn for online skills, completing modules or engaging in a community.

Digital Badges

Think back to your childhood, you may have been a scout or guide and been awarded a badge for attaining a proficiency such as knot tying or map reading. This reward provided recognition of an achievement for the person to record and demonstrate they had been assessed and deemed competent in a skill. With the online world increasing in education delivery it is important to recognise achievements. Digital badges are a method of recognition, you can then store them in a digital backpack.

Digital Open Badges are:

  • Free and open: “Mozilla Open Badges is not proprietary. It’s free software and an open technical standard any organization can use to create, issue and verify digital badges.
  • Transferable: Collect badges from multiple sources, online and off, into a single backpack. Then display your skills and achievements on social networking profiles, job sites, websites and more.
  • Stackable: Whether they’re issued by one organization or many, badges can build upon each other and be stacked to tell the full story of your skills and achievements.
  • Evidence-based: Open Badges are information-rich. Each badge has important metadata which is hard-coded into the badge image file itself that links back to the issuer, criteria and verifying evidence”.

From MozillaWiki (2014).

Digital Open Badges make it easy to:

  • “Get recognition for the things you learn,
  • Give recognition for the things you teach,
  • Verify skills,
  • Display your verified badges across the web”.

From MozillaWiki (2014).

Your Recognition For Reading This Blog

Claim you Electronic badge [link here] as reward for supporting Nursing Education Network and engaging in emerging technology and ideas.

Claim Code: A1E-D0FA-5D6

Creating a Badge

The below references provide a guide to digital badges, and the available resources to create simple digital badges. My experience was to try the free websites and use very simple processes for creating open badges, which you can see above as my first attempt. If I had the coding skills I would like to create, bake and complete a digital badge to share on open access (one for the future).


Mozilla (2016) Open Badges

Mozilla Wiki (2014) Badges

Badge Alliance (2016) Badge Issuing Platforms

Wikipedia (2016) Digital Badge

Blackall, L. (2015). Displaying ONPhD badges


Nano & Micro Future of Health & Education

Recent online posts on nanotechnologies and terminologies caught my attention and even though they were from different specialty areas, the themes were all related, in particular looking into the future of work and education. As they were both healthcare and education they aligned perfectly in my areas of interest.


The terms NanodegreeMicrodegree and Micocredential in the future may become part of our education make-up according to Jeffrey Young (EdSurge, 2016). The shorter and focused courses, often delivered online may then be able to be used for work accreditation, or bundled together to form the equivalent of a traditional degree. This approach could create a new route away from traditional education pathways, potentially more accessible than the high cost of many countries in their approach to higher education. It will all be about credentialing and if employers recognise such education. Young also warns that the traditional universities have been and will likely still be around for a long time to come.

This blog is created with a micro-learning approach for quick learning on the go.


Nanotechnology, Nanorobots and Nanodevices all with the potential to deliver or operate at the specific site that is required, rather than impacting the whole body and potential immune responses from the host. Mesco (2016) states that “the word symptom would be completely eradicated from our medical dictionaries”. @Berci provides more discussion on the potential power of nanotechnology in healthcare in his book The Guide to the Future of Medicine: technology and the human touch (2014).

Nano: The unit of measurement is in nanometer. A nanometer is a million times smaller than the length of an ant.

Keywords:  Nanodegree; Microdegree; Micocredential; Nanotechnology; Nanorobots; Nanodevices; Nanometer; @Berci.


Mesco, B. (2016) Nanotechnology in Healthcare: Getting Smaller and Smarter. The Medical Futurist

Young, J. R. (2016) Why Udacity and EdX Want to Trademark the Degrees of the Future-and What’s at Stake for Students. EdSurge

Mesko, B. (2014). The guide to the future of medicine: technology and the human touch. Webicina kft. [link to free chapter]

Wikipedia (2016) Nanotechnology Portal


Piaget:Constructivism & Cognitivist Perspective

Constructivism & Cognitivist Perspective

Considered one of the most prominent and prolific constructivists, Jean Piaget developed the theory of cognitive development around the premise that thoughts, memory, past experience, problem solving and processing information all influence the learner (Doolittle and Hicks, 2012).  Piaget’s four stages of cognitive development changed the education paradigm from a traditional passive and transference process into one that the individual constructs knowledge and becomes an active learner (Brown and Desforges, 2007).

Piaget’s four stages of cognitive development are:

  • Sensorimotor stage (birth to 2 years)
  • Pre-operational stage (2 to 7 years)
  • Concrete operational stage (7 to 12 years)
  • Formal operational stage (12 years onward)

Ideas, thoughts and knowledge development that exist in memory according to Piaget are termed schema. The concept of schema theory involves the organised structure of memories, past experience and the knowledge we possess and develop over time (Winn and Snyder, 1996). This constant interpretation and adaption is according to Piaget, the process of adaption and assimilation to the environment. Adaption are the skills to develop cognitively to progress and continually learn, progress and remain challenged. Accommodation is when the new knowledge or the existing schema do not work, the requirement of a different perspective or even changes need to occur for ongoing learning opportunities and development. Assimilation is using new experiences to already existing schema, knowledge and experiences.

To succinctly summarise cognitive perspective learning theory, “learners learn how to learn” (Biggs and Tang, 2007). The cognitive approach requires active participation and educational approaches to encourage interaction to realise potential (Killen, 2012). This educational approach generates meaning from the interactions in learning and the view of one’s self and internal organisation of knowledge. The structured learning environment means the teacher becomes a facilitator of learning rather than the provider of information (Killen, 2012).

Central to this cognitive representation and subsequent theories from Piaget’s extensive research is the focus of the development and education of children, rather than adults. One element of conjecture with Piaget is the four stages take the learner from birth (sensorimotor stage) to childhood (formal operational stage), but lacks the relevancy for the adult learner (McLeod, 2009).


Biggs, J., & Tang, Catherine. (2011). Teaching For Quality Learning At University (4th ed.). Maidenhead: McGraw-Hill Education. [sample here]

Brown, G., & Desforges, C. (2007). Piaget’s Theory: A psychological critique. Hoboken: Taylor and Francis.

Doolittle, P. E., & Hicks, D. (2003). Constructivism as a theoretical foundation for the use of technology in social studies. Theory & Research in Social Education, 31(1), 72-104.

Killen, R. (2012). Effective teaching strategies: Lessons from research and practice. Melbourne: Cengage Learning Australia.

McLeod, S. A. (2009). Jean Piaget. Retrieved from

Rungapadiachy, D. M. (1999) Interpersonal communication and psychology for health care professionals. Theory and practice. Oxford: Butterworth-Heinemann.

Winn, W., & Snyder, D. (1996). Cognitive perspectives in psychology. Handbook of research for educational communications and technology: A project of the Association for Educational Communications and Technology, 79-112.



The Networked Student

The networked learner model provides students with a way to create a personal learning environment where meaningful learning occurs with knowledge construction. “Knowledge based on experiences and social interactions”(Drexler, 2010).

Principles of networked learning are around connectivism and constructivism. Social learning theory is also part of this approach as an array of resources are sourced from personal learning environments.

Development Aims of Networked Learning (Drexler, 2010):

  1. Contacts.
  2. Synchronous communication.
  3. Information management.
  4. Social networks.

Due to technology, the connectivity aspect is now embedded in our study, work and personal lives thanks to internet access on mobile phones, tablets and laptops. This allows learning to be mobile, agile and provide constant learning opportunities. Learners can also be creators and collaborators of learning, not just consumers.

Learning Aims:

  • Promotes inquiry-based learning.
  • Promotes digital literacy.
  • Empowers the learner.
  • Build professional connections to support practice.
  • Build a purpose of independent inquiry.
  • Flexibility as new technologies emerge.

How to Deliver (Educator Perspective): An educator can scaffold a networked learning approach to allow students to take more control of the learning process. The teacher could provide details of reliable and quality sources of information available to students.

The educator can decide on the types of resources students are to use. Remember to always consider, “what are the students using in their everyday lives”, if they use them then you really need to justify using closed off and password protected applications, as the learning network will become very restricted to a single institution. Emerging web applications and open educational resources are integrated to support a “Networked Student Model”. Why not engage yourself in the technology and source the good resources out and become a guide? You will find instead of creating resources, you will spend more time sourcing information in the mass of information on the web.

Networked Student

Keywords: networked learning; MOOC; personal learning network; web 2.0; connectivism; scaffolding.


Drexler, W. (2010) The networked student model for construction of personal learning environments: Balancing teacher control and student autonomyAustralasian Journal of Educational Technology, 26(3), 369-385.

Wikipedia. (2016) Networked Learning.

Nursing Education Network. (2016) The Networked Teacher.

Gamification In Nurse Education

Educational Need for Gamification?

“a motivated learner can’t be stopped” (Prensky, 2003, pg. 1).

“Unfortunately, in this day and age much of the content that needs to be learned by students is not directly motivating to them and the word ‘boring’, or one of its politically correct synonyms such as ‘dry’ and ‘technical’ often crosses their lips – whether the learners be in school, college, corporations, professions, or even the military” (Prensky, 2003, pg. 1).

Benefits of Gamification

  • Goal orientated learning.
  • Fun.
  • Motivates.
  • Captures interest.
  • Problem solving.
  • Opportunity to design and create (coding).
  • Can create friendly competition.
  • Incentives.
  • Badges for achievement.
  • Safe environment to explore, succeed and importantly fail.
  • Provides timely feedback.
  • Social learning.
  • Scaffold learning as progress through a game.
  • Learning is visible.
  • Develops learner for higher IT skills.
  • Tracking and analytics (especially for the educator).

Gamification Examples for Adult Learners 

  • Pokemon Go
  • SICKO (Surgical decision-making from Stanford Uni)
  • Septris (Sepsis management from Stanford Uni)
  • Traffic Light Lets You Play Pong

Gaming Stats

  • In recent years, the video game industry has become the leading form of entertainment in terms of global total revenue.
  • In the United States, it surpassed the movie and music industries in 2005 and 2007, respectively, and in 2013, it is expected to exceed $76 billion globally.
  • More than half of Americans (58%) play video games, with an average of two gamers in each gameplaying household.
  • Forty percent of all gamers are female.
  • And contrary to popular belief that only teenagers play video games, 49% of gamers are between ages 18 and 49.3.
  • Only 25% of gamers are under 18, and 26% of gamers are over age 50; the average gamer spends 13 hours a week playing video games.

(Tsui, Lau & Shieh, 2014)

Gamification for Nurses? 

The digital citizen and digital nursing student are now among us and so we need to consider if the nursing workforce are ready for gaming as part of their ongoing educational needs? The data above shows age and sex aren’t major factors in what is likely a presumed male dominated educational approach. So it’s time to develop and engage in gamification and measure the effectiveness for nursing education.

Keywords: Gaming, gamification, play, learning, networking, human mind.

Relevant Posts:


Prensky, M. (2003). Digital game-based learning. Computers in Entertainment (CIE), 1(1), 21-21.

Mesko, B. (2016) Tips For How To Use Web 20 In Medicine (2007)

Tsui, J., Lau, J., & Shieh, L. (2014). Septris and SICKO: implementing and using learning analytics and gamification in medical education. Educause, March.

Graafland M, Schraagen JM, Schijven MP. Systematic review of serious games for medical education and surgical skills training. Br J Surg. 2012 Oct 1;99(10):1322–30.


The Art and Science of Game Based Learning Infographic

The Normalization of Deviance in Healthcare Delivery

Journal Club Review Article: 

Banja, J. (2010). The normalization of deviance in healthcare deliveryBusiness Horizons, 53(2), 139.           


“The failure of health professionals to comply with standards, rules, or regulations is a fundamental cause of such breaches.”

When violations of practice standards are intentional, this can become the norm within a group of professionals or across a unit. This practice can then become normalised and compliance failures become the norm.

Just think to everyday practice, how many incidences does a nurse or doctor complete a task and bend the rules a little to get the job done? The risk is this becomes the norm and a culture of deviations is created. We end up inadvertently downgrading the policies and procedures that were created as the safety net.

Concepts & Discussion

Errors- can be active or latent (e.g. a procedure).

3.1 The rules are stupid and inefficient (pg. 4)

  • Justification for breaking the rules, then you are at risk of taking the workforce along with you. Think role modelling here. 
  • Nurses are skilled at getting around rules?

3.2 Knowledge is imperfect and uneven (pg. 5)

  • Knowing rules, guidelines, why does the guideline exist?
  • How many rules or checklists are you expected to know in your daily practice? Infection control is potentially one of the examples where practice differs. This may lead to the missing risk minimisation aspect.

3.3 The work itself, along with new technology, can disrupt work behaviours and rule compliance (pg. 5)

  • It can be hard to keep up with technology changes (especially if the investment in training and education has not occurred).
  • Changes well known and understood processes, this causes major disruption to the workforce.

3.4 Break the rule for the good of the patient (pg. 5)

  • The justification aspect. The example used by Banja is of the health professional removing the tip of the index finger to feel for the vein, this breaks infection and safety prevention rules but is undertaken for a practical solution that helps avoid multiple attempts.

3.5 The rules don’t apply to me/you can trust me (pg. 5)

  • Ownership or presuming everyone has best intentions.  Nurses having to hold one another to account. This is the difficult aspect, especially as in a workplace hierarchy and power relationships exist.

3.6 Workers are afraid to speak up (pg. 6)

  • The difficulty of speaking up, holding to account, the traditional hierarchies of seniority, nurse to medical, cultural. What deviations do we accept?

3.7 Leadership withholding or diluting findings on system problems (pg. 6)


  • Need to pick up signals (from incident reporting, audits, feedback).
  • Feedback from the workforce. Change from the traditional hierarchy and make a floor up not a top down system.
  • Auditing.
  • Review and test some common practice – disposing of drug errors, lack of equipment.
  • Pay attention to the weak signals (Swiss cheese effect).
  • Resist the urge to be optimistic.
  • Create an environment and culture to feel safe to speak up.
  • No blame culture, it is the system under review.

For The Educator To Consider

Think of your own habits and deviations, we all role model the behaviour in education.

When new rules to practice are introduced, think about the consequences and logistics of this practice change to all levels of staff. 

Take a copy of this article and hold a journal club discussion with your colleagues, see if this occurs in your unit, what others’ views are on this topic. It should hopefully generate some good robust discussion.


Banja, J. (2010). The normalization of deviance in healthcare deliveryBusiness Horizons, 53(2), 139.

Big thanks to Timbo for suggesting this article to review.

Eportfolios in nursing

Portfolio approach: Eportfolios

Knowles (1975) assumptions of adult learners being self-directed, self-motivated, readiness to learn and having rich past experience are the basis for the framework of portfolio development and a reflective approach to learning. Joyce (2005) emphasises the development opportunities of a portfolio as the student takes charge of their learning. In nursing, a practice-based portfolio is part of role development and career progression, but is fundamentally maintained for evidence of continuing professional development required for nursing registration standards. Education time and reflection are required documentation for minimum standards.

Two types of nursing portfolio exist according to Oermann (2002):

  1. Best Practice.
  2. Growth and Development.

The e-portfolio uses a multimedia platform to represent learning over an education journey (Green, Wyllie & Jackson, 2014) . The strategy of incorporating an e-portfolio into nurse education for lifelong learning and enhancing personal and professional development means e-portfolios are now more than just an online curriculum vitae (Green, Wyllie & Jackson, 2014). E-portfolio’s allow for regular feedback, progression and development. E-portfolios can be succinctly summarised as “Collect, select, reflect and connect” Clark and Eynon (2009) (cited Green et al, 2014).

Education Theory

Nurse education theory (from undergraduate to postgraduate), key characteristics involve experiential learning and Kolb’s cycle (Quinn, 2000, pg. 62). For professional practice development, use of Schon’s reflective practice and the “reflecting in action, reflecting on action” methodology are teaching strategies common in nursing education (Quinn, 2000, pg. 568).

Regular progress review is considered a requirement in the clinical healthcare setting through performance appraisals (Green et al, 2014).  Predetermined minimum standards of professional nursing domains are expected requirements for successful completion of both undergraduate and postgraduate nursing courses.

E-Portfolio Examples

  • Simple methods include your hard drive, a memory stick (have a back up when it goes missing!) or use Google Drive or Microsoft OneDrive.
  • A blog or wiki as a collection of resources can be an e-portfolio.
  • E-Portfolio Software such as:
  • Your CV- use LinkedIn.


Green, J., Wyllie, A., & Jackson, D. (2014). Electronic portfolios in nursing education: a review of the literature. Nurse education in practice, 14(1), 4-8

Joyce, P. (2005). A framework for portfolio development in postgraduate nursing practice. Journal of Clinical Nursing, 14(4), 456-463.

Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2014). The adult learner: The definitive classic in adult education and human resource development. Routledge.

Oermann, M. H. (2002). Developing a professional portfolio in nursing. Orthopaedic Nursing, 21(2), 73-78.

Quinn, F. M. (2000). The principles and practice of nurse education. Nelson Thornes


Social Media: Where are the nurse leaders?

“Unfortunately, many nurse leaders, with years of experience in this multifaceted profession, have yet to join the conversation on social media. Therefore, the conversation is often led by novices in the field, simply because leaders are absent” (Carroll & Bruno, 2016).

As social media continues to change the face of healthcare, the necessity to understand and engage will become increasingly important to connect with colleagues, patients and other health systems. The flattening of healthcare hierarchies opens up the need to connect.

Evidence to persuade the doubters:

  • The creators of #WeNurses (Moorley & Chinn, 2014).
  • Evidence of using a hashtag at a conference and potential benefits, increased advertising, awareness for university and self-promotion (Wilson, Ranse, Cashin & McNamara, 2013).
  • Symplur: provides the analytics to provide quantitative analysis. Healthcare hashtags project on tweet chats, conferences that is a free open platform that connects to relevant conversations and communities.


• The development of social networks.
• The student/staff experience through improved student/staff partnerships.
• Utilisation of analytic tools to engage students and stimulate learning.
• Development of academic staff usage of social media.

Some Players

Just to counteract the above points, the following provide some great higher level healthcare insights.

Keywords: Social media, community of practice, collaboration, network, communication, evidence based practice, professional development, global citizen.


Moorley, C., & Chinn, T. (2014). Using social media for continuous professional development. Journal of Advanced Nursing.

Moorley, C. R., & Chinn, T. (2014). Nursing and Twitter: Creating an online community using hashtags. Collegian, 21(2), 103-109.

Carroll, C. L., & Bruno, K. (2016). Social Media and Free Open Access Medical Education: The Future of Medical and Nursing Education. American Journal of Critical Care, 25(1), 93-96.

Sinclair, W., McLoughlin, M., & Warne, T. (2015). To Twitter to Woo: Harnessing the power of social media (SoMe) in nurse education to enhance the student’s experience. Nurse Education in Practice, 15(6), 507-511.

Wilson, R., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian. Chicago.

Symplur. (2015) Doing research in healthcare social media.

Flipped Classroom

A reversal of the traditional lecture then do homework approach. ‘Flipping’ allows a change in the teaching approach and levels of engagement.  In the flipped classroom the reading is completed before attending an interactive session (instead of a potentially passive lecture). The pre-reading covers the content that was previously delivered in the lecture format. This means a more interactive, problem based learning and group work teaching format can be utilised within the valuable teaching time.

How To Deliver?

Set pre-reading, links to suitable resources and also access to the lecture notes to enable learners understand the key readings and focus points (intended learning outcomes). Students can work at their own pace.

Pre-Reading resources:

  • Book or journal article
  • Video
  • Podcast

E-learning provides an opportunity to access and engage with resources pre-education.

This allows the discussion to extend and develop further as the groundwork is set. The facilitator can spend time clarifying any theory or concepts that the learners struggled with.

Education Delivery:

  • Problem based approach (case study)
  • Group work
  • Quiz
  • Project
  • Hands on
  • Simulation


What happens though when some of the learners have engaged with the pre-reading and the other half have not done a thing? You now have two split groups and you have to decide to bring one group up to speed or push on with the advanced group and leave the others behind. To utilise the flipped classroom then a ‘ways of working’ between the learners and teacher has to have taken place, then expectations are clear for the adult learners.

Loss of the lecture, it is easy to say lectures are passive but this is not always the case, there are great presenters that provide interaction, learning and engagement so dont be too hasty removing this approach.

The flipped classroom does seem very similar to the seminar approach to learning, so it’s not really that much of a learning curve when you look at it in constructive manner.

Keywords: flipped classroom, pre-reading, active learning, engagement.


Tucker, B. (2012). The flipped classroom. Education next, 12(1).

Educause (2012) 7 things you should know about flipped classrooms

McLaughlin, J. E., Roth, M. T., Glatt, D. M., Gharkholonarehe, N., Davidson, C. A., Griffin, L. M., … & Mumper, R. J. (2014). The flipped classroom: a course redesign to foster learning and engagement in a health professions school. Academic Medicine, 89(2), 236-243.