Teaching a Second Year Student Nurse About Cardiac Medications - Case Study Example

A Reflective Critical Analysis of a Teaching Skill: Teaching a Second Year Student Nurse About Cardiac Medications This paper presents a reflective critical analysis of a teaching skill from a specific teaching session. The goal of the teaching session is for a second year student nurse to acquire fundamental knowledge pertaining to the administration of cardiac drugs and the corresponding systemic effect of such medication on a patient. Prior to the teaching session, the learning need of the student nurse which had to be addressed in that session was identified. Recognition of the learning need was based on the difficulties encountered by the student nurse during the previous drug round. During this first drug round which took place in the clinical room of a cardiac ward, the student nurse was able to identify the five R’s which should be checked before administering medication to patients (Nursing and Midwifery Council 2008). However, the student nurse was not able to recognise the cardiac tablets, as well as their indications and interactions. Because of the apparent difficulties manifested in the student’s competency on this particular topic, this author decided that a remedial teaching session should be scheduled to attend to the perceived learning need. The setting of the teaching session was also in the same clinic room of the cardiac ward of a hospital, conducted from 30 to 45 minutes at night time after the shift. This was the most convenient time for both the mentor and the student. Based on the student’s performance during the past lessons, the student may be classified as an average learner. Preparations for the Teaching Session As preparation for the teaching session appropriate teaching strategies and methods were planned. The teaching strategies selected for the session was one-on-one approach and brainstorming. Meanwhile, the teaching methods adopted for the teaching session were independent or self-directed learning, pre-session taught questionnaires to facilitate in the identification of specific learning objectives and experiential/reflective teaching and learning. As part of independent or self-directed learning, the student nurse was assigned to select two cardiac medications and study their indications and interaction. On the other hand, as part of the experiential/reflective learning, the student was also requested to select two cardiac patients from the ward who are currently on cardiac medication which the student may observe and interact with during teacher-directed learning sessions following the hospital and curricular policies regarding the practical academic exercise.. Learning aides used to assist self –directed learning were given a week before the scheduled teaching session. These learning aides include pre-session questionnaire for review and a list of suggested readings (Wulsin 2007; Woods et al 2005) The Teaching Session This part of the critical analysis incorporates theoretical foundations to justify the use of a particular teaching strategy or method. Reactions of the learner to the teaching approach were also noted. One-on-one vs. group discussion One-on-one instruction was a natural choice for teaching strategy. Fitzgerald (2008) defines one-on-one teaching as one which “involved delivering information specifically designed to meets the needs of an individual learner” (p 437). In this learning approach, both the mentor and the learner communicate knowledge, ideas and feelings orally, and as such a learning activity designed using this strategy is not supposed to be a lecture to a “class of one”. Group discussion, on the other hand, which is defined as a “meeting for an exchange of ideas” and is a mentor-directed discussion of concepts and ideas (Rowles 2005 p 307). The one-on-one approach was chosen as the teaching strategy over group discussion, motivated by the revelations in Stronge, Tucker and Hindman (2004) that one-on-one teaching enhanced student performance by about two standard deviations higher than conventional classroom-based teaching. Dudley-Evans and St. John (2007) also injected the biggest encouragement for the utilisation of this approach in that through one-on-on teaching, the mentor matches the student’s pace in learning. Wilberg (cited in Dudley-Evans et al 2007) even likened the process of learning to a partnered dance routine where the mentor takes the role of a partner who adjusts to the tempo and the pace of the student in order to guide and succeed in the endeavour. It should be stressed, however, at this juncture, though, that the one-on-one approach and the group discussion strategy have their own set advantages and disadvantages in facilitating learning. Among the primary advantages of the one-on-one approach are: (1) possibility of adapting the tempo and elements of the lesson to the perceived need(s) of the learner; (2) strategy is believed to be the best intervention for preliminary and on-going evaluation of the learner; (3) applicable in teaching behavioural knowledge or skills in all the three domains of learning (i. e. cognitive, affective and psychomotor domains); and (5) offers instantaneous feedback on the part of both the mentor and the learner (Fitzgerald 2008). Feedback is an important aspect of mentoring which should not be relegated to the side (Gopee, 2008). In spite of its outstanding advantages as a teaching strategy, the one-on-one approach also presents a number of limitations. Among these are: (1) the tendency for the learner to be secluded from other learners who have similar difficulties or learning issues; (2) the approach does not offer a chance for the learner to interact with other learners to compare ideas with or share ideas and feelings under the same situation; (3) tends to put the learner in a very difficult situation being the centre of the mentor’s attention during the whole situation; (4) application of the questioning technique by the mentor to direct the exchange of ideas may sometimes be mistaken as an assessment and not a teaching procedure; (5) tends to overwhelm the learner with too much knowledge when the session tackles to broad a coverage, which the learner finds difficulty processing (Fitzgerald 2008). Group discussion, on the other hand, offers the following advantages: (1) encourages student participation with respect to the content of the discussion; (2) assists in the acquisition of understanding and in the use of concepts learned to practical applications; (3) helps enhance articulation and thinking skills; (4) requires minimal development time for the lesson preparation; and (5) does not demand additional resources such as hand-outs or audiovisual media (Rowles 2005). In addition to the above advantages, Fitzgerald (2008) added the following strengths of group discussion in reinforcing learning : its utility in enhancing both the affective and cognitive domains and in forging student bonds through peer support and feelings of belongingness Disadvantages of group discussion, mainly have something to do with the difficulties which learners may be subjected to, which include: the need for learners to possess adequate knowledge of the topic to encourage active participation; and longer preparation time for the learners. Use of this approach sometimes allow students to leave the discussion without having fulfilled the learning objectives of the session (Rowles 2005). Additional limitations discussed in Fitzgerald (2008) deal with issues which present challenges for the teacher using the strategy, including: possibility of only one student dominating the discussion; or when learners do not readily interact, especially for a novice teacher; time consuming and the need for the presence of the mentor in all sessions. Since no single teaching strategy is believed to be universally superior for use with all types of learners (Stronge et al 2004), it is important the a mentor selects a strategy which will influence student learning for a specific learning objective. For this particular teaching session, only one of the students manifested difficulties in the identification of cardiac medication and their indications and interactions. It would have been gainful for other students, if a small group were invited for the teaching session so that their learning of the previous lesson may be reinforced during the activity. However, there was a last minute decision to stick with the one-on-one approach after pondering on the limitations of both approaches. Decision against a small group discussion was propelled with apprehensions that the single student who was the object of the designed teaching session may slip out of the discussion without having a full grasp of the competency expected after the session. Space constraint and scheduling difficulties were two other considerations which pivoted the selection of the one-on-one teaching strategy as the main strategy most appropriate for the teaching session. Use of a support teaching strategy to make up for some limitations of the one-on-one approach To support the one-on-one approach, and to encourage exchange of ideas during the teaching session, brainstorming was also utilised as a teaching strategy. As Tileston (2004) maintained, brainstorming brings out many ideas on the table. Andriopoulos and Dawson. (2009) traced the beginnings of a structured process for creative problem solving to the use of brainstorming. For mentors like me who regard teaching also as an art, devising an intervention for a nursing student who finds difficulty in identifying medication for a particular ailment, together with the indications and interactions of this drug, entails a creative teaching solution. Brainstorming provides many advantages aside from generation of many ideas, such as: fostering creativity, its potency to overcome limited thinking and the simplicity of the process mechanics for use on the part of the mentor and to understand on the part of the learner (Leigh 2006). The brainstorming process is also enjoyable, enhances personal growth and well-being and improves the morale of the learner (Andriopoulos et al 2009). It was also noted from available literature that the limitations identified about brainstorming deals more with its structure as some claimed that the process itself is incomplete because it is simply a segment of the problem-solving process, and that the strategy is highly participative. Another minor limitation of brainstorming as claimed is the misleading name, which have evoked negative association with brainwashing or mental problems (Leigh 2006). Self-directed vs. teacher-directed learning Self-directed learning is defined as “any increase in knowledge, skill, accomplishment, or personal development that an individual selects and brings about by his or her own efforts using any method in any circumstances at any time”, while teacher-directed learning is “any increase in a student’s knowledge or skill brought about by initiatives taken by a teacher” (Gibbons 2002 p 2). Teacher initiatives include choice of the learning to be acquired, how such knowledge is to be presented, assignments and exercises and assessment. To maximise the odds for success of this planned intervention, a combination of self-directed and teacher-directed learning were adopted as teaching methods. The intervention involved a one-week preparation on the part of the student, which was actually an application of independent or self-directed learning as a teaching methodology. Contrary to the belief that independent learning results from individual objectives and behaviours, Harvey and Chickie-Wolfe (2007) argued that independent learning is “actually socially mediated” (p 24). Studying and learning independently implies that although it is the individual learner who regulates his/her own behaviours, the capacity to self-regulate tends to be influenced by environmental variables, which are not generally available. In this case, encouragement on the part of the mentor for the student to undergo an intervention served as the social mediator. The student’s choice of which two cardiac drugs to concentrate on, including mastery of the indications, interaction and side effects of the drugs were part of the self-directed learning. The student’s own choice of which two patients to observe in order to relate the cardiac drugs to the patients’ condition were also, in effect a component of self directed learning. As Hunter (2004) puts it, there are skills or knowledge for which it is best for the students themselves be independent learners. The preparations for the session articulated in the first section of this paper were, in effect, part of teacher-directed learning. As the actual session progressed, the student presented the case of Mr. X with the aid of printouts of Powerpoint slides. The teacher-mentor team discussed the cardiac drugs and how these medications related to the symptoms and treatment of the patient in the brainstorming process where ideas flowed naturally. In retrospect, even if the mentor were present and exchanging ideas with the student, what actually transpired was a student-learning where the mentor facilitated the student’s assessment of his own work, as suggested in Gibbons (2002). The brainstorming process also revealed student recall of the symptoms and actions of the medications and a mastery of the competency required for the topic, which again showed the teacher’s role of guiding students through self-directed activities (Kalaja and Barcelos 2006). Importance of communicating learning objectives and expectations Equally important as the selection of significant learning objectives and exercises is the communication of learning objectives before the start of a learning activity (Burden 2000). In this regard, the pre-prepared guide questionnaires with learning objectives handed to the student a week prior to the teaching session for review served the purpose. At the beginning of the session, these learning goals and expected outcomes were reiterated, this time, orally by the mentor. An understanding of the objectives of the session was believed to be instrumental in clarifying to the student that the brainstorming is a good vehicle to express ideas about what was learned during the one-week preparation. In this regard, levelling of expectations served both as a teaching methodology and a powerful session (in lieu of class) management technique. Reflective or experiential learning Mashaba and Brink (1994) generalised that most aspects of the nursing curriculum may be taught, and eventually learned using experiential learning. Taking the cue from Mashaba et al, the mentor found the utility of this teaching methodology for the teaching session. Experiential learning focuses on the “student or learner being offered an experience, followed by reflection and making sense of the experience” (Mashaba et al 1994 p 157). Assignment of patients from which to observe symptoms and the corresponding effects of the cardiac medication being administered is a facet of experiential learning. The blending of theory from the books assigned and the guide questionnaires with the actual experience of relating the symptoms of the patients and the outcome of taking in the medications, facilitated by a host of educational strategies and methods all contributed to a wholesome and satisfactory teaching experience for the mentor and learning activity for the student. In a way, the session was a fruitful endeavour which culminated in linking theory with practice (Howard 2004). From the teaching session, the mentor learned that teaching in a night schedule may not be the best time because of the natural human body clock and the tremendous daytime activities of a teaching nursing practitioner. It was also confirmed from this session that use of pre-prepared guide questionnaires helps in internalising of learning objectives and focusing student efforts on a specific topic. The one-on-one approach works was found to work well for planned learning interventions. In conclusion, the use teaching strategies and methods in combination contributed to the overall success of the intervention because each of the strategies complemented the methods. Hence, proper planning is necessary to ensure that the lesson plan is not just a showcase of the mentor’s knowledge of teaching strategies and methods, but rather, a testament that the learning activity has the potential to develop learning further with the aide of carefully chosen elements, crafted to encourage and motivate students to embark on a learning journey with the teacher as guide. Bibliography Andriopoulos, C. and P. Dawson. 2009. Managing change, creativity and innovation. London: Sage Publications, Ltd. Burden, P. R. 2000. Powerful classroom management strategies: Motivating students to learn. London: Corwin Press/Sage Publication, Ltd. Dudley-Evans, T. and M. J. St. John. 2007. Developments in English for specific purposes: A multidisciplinary approach. Cambridge, UK: Cambridge University Press. Fitzgerald, K. 2008. Instructional Methods and Settings. In Nurse as educator: Principles of teaching and learning for nursing practice, edited by S. B. Bastable, 429-472. 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Treating the aching heart: A guide to depression, stress, and heart disease. Nashville, TN: Vanderbuilt University Press. Read More