The Educational Cognitive Theory in Nursing Teaching and Learning - Report Example

The Cognitive Theory in Nursing (Institution) (Name) (Course) (Module) (Instructor) Date of submission Introduction Nursing education is an integral part of the healthcare system in any country. The quality of nursing education and practice has a great bearing on the healthcare sector in that country. The health of the healthcare service consumers highly depend not only on the practicing nurse and doctors but also on the competence of their teachers and trainers who imparted the practising knowledge. This intricate relationship underlines the importance of nursing education and the use of educational theories in imparting knowledge on nursing students. A number of educational theories have been used in nursing education over several decades. Some of these educational theories are behavioural, social cognitive, humanistic among others. One of the most widely used educational theory in nursing in social cognitive theory. This theory basically emphasises on the intellectual abilities with three core instructional levels; fact, understanding and application. This paper will investigate the use of the educational cognitive theory of learning in nursing education and its application in practice. Discussion: The educational cognitive theory in nursing teaching and learning The cognitive approach, like other theories in education provides a direction for teaching and learning. A theory comes in handy in organizing learning, naming and labelling certain activities. They provide consistency and stability for trainers and teachers and helps them monitor progress and changes in a particular field of knowledge (Bonnel & Smith, 2010, 32). Chinn and Krammer (2004, 51) say that theories organise ideas in a manner that projects “tentative, purposeful and systematic view of phenomena.” In the teaching context, then theories provide a means of structuring ideas about teaching in a systematic way. Nonetheless, it must be noted here that theories do not necessarily provide knowledge; they just play a facilitator role in organising ideas but are not a source of ideas themselves. As such, nursing teachers must first identify the content that they wish to teach and then apply the theory. The cognitive theory proposes a hypothesis which helps determine causal interrelationships and organises facts to provide direction and predictability. Lewin, one of the developers of this theory states that reality for any one person is what he or she personally perceives it and experiences it. As such, everything exists as a function of personal experience (Bevis 1989). Therefore, each individual sizes up things and situations and their perceptions of that becomes reality to them. This can be understood from the nursing point of view for instance to explain sickness. A nurse will only access the level of sickness depending on her or his experience with health. Health in this case is not one sided as it encompasses many areas. This brings up the issue of wholeness or many directions in the cognitive of learning which is critical in teaching nursing. Developers of the cognitive theory believe that individuals respond to whole situations and patterns rather than parts. These developers, the gestalt psychologists in Germany, individuals are more interested in interrelationships and patterns in phenomena rather than looking at each actor individually. They further showed that insight is primarily a matter of perception through a mental trial and error process in an effort to organize and interpret components of the stimulus situation. Meaning is thus derived from seeing the relationships between components of the whole rather than the components themselves. Bevis (1989) calls the active participation of man in his environment/situation as a ‘simultaneous mutual interaction” (80). Through perception, a learner not only becomes conscious of his environment but also becomes familiar with it. The cognitive theory defines learning as an active, cumulative constructive process that is goal oriented and dependent on the learners’ mental activities. In this theory, students have an active as opposed to a passive role to play in that learners internally modify knowledge to suit their experiences. It implies that the transfer of knowledge from the teacher to the learner through a number of means such as online, class lectures etc does not automatically result into learning. Students must discover meaning of the knowledge they receive by using information processing strategies memories and attentional and motivational mechanisms to organise and understand it (Billings & Halstead 2005). Motivation is based on the learners’ goals and expectations in cognitive theory. Individuals with high expectations of themselves are motivated to act while those with low expectations have little motivation to act. However, when expectations are too high, disappointment and frustrations may set in where the set goals are not realised. High motivation often encourages an internal locus control where learners are well aware that they have themselves alone to blame in case of their failures. By using this motivation principle in cognitive theory, educators are able to assess the readiness to learn and provide a variety of meaningful and developmentally appropriate experience to the learners which allows them to discover what they learn for themselves. In this sense, education comes out as a social experience that “benefits the human interactions, enhances learning and fosters an appreciation for the rich in human thought” (Butts & Rich 2010, 214). Educators on the other hand should use learners’ knowledge as their motivation. Butts and Rich (2010) state that instructors need to develop clear expectations from learners in terms of knowledge. They indicate that instructors should state clearly in their notes the expected outcomes from students in terms of knowledge gained. They add that this is enforced by good organisation of teaching material and structured approach to presenting information in a manner that is easily understood and learners to discover what they have learned themselves. Butts and Rich (2010) add that instructors need to allow room for learners to engage their cognitive skills in the learning process where their creativity and originality in thought is put to test. Such issues should not be relegated to tests and exams only. Bevis (1989) notes that one of the best ways to allow learners to engage their cognitive abilities and experience with knowledge is to allow learners to challenge conventional viewpoints and even those held by the instructor. In short they learners should be allowed to think outside the box deductively. This according to Butts and Rich (2010), in the cognitive theory context, allows the instructor to have a peek on how learners have adapted knowledge received with their social and personal influences. Personal experience and social influences on part of the leaner contributes towards reflection. One of the renowned scholars in nursing, John Dewey, described reflection as a process of inquiry. It involves absorbing, weighing, speculating, contemplating and deliberating on a situation, experience or a collection of information (Bevis 1989; Butts and Rich 2010). This sets the framework for reasoned action or attaching meaning to an experience. The works of Schon, another scholar, clearly touch on this issue of reflection in nursing theory and practice. He compares reflection to problem solving and points out that the traditional means of teaching and learning result in rigid structures of problem solving where the results are clear and predictable which is not the case in nursing or healthcare in general (Lowenstein & Bradshaw 2004). This gives rise to the debate on nursing education on whether it is best attained in practice or in theory as guided by ideological, educational and professional approaches. Problem based learning and reflection as proposed by Dewey is proving more popular than the traditional problem solving in teaching ethics. However, the approach is faced with numerous challenges on ethical basis. Rideout (2001, 14) cites Hangreaves who captures this dilemma well by saying that Reflective practice is not simply re-examining someone’s case, it involves personal interpretation and judgement. The reflector may be recording incidents….which would not otherwise be recorded, and ma be controversial. This raises questions about the nature and ownership of knowledge and the responsibilities of people who have such knowledge…considerations of rigour, authenticity and informed consent need to be addressed (Hangreaves 1997, 223). From this, it is apparent that reflection learning as a type of problem based learning is prone to ethical breaches. Rideout (2001) writes that there are limited techniques that have been developed by scholars through which nursing students can learn ethics in problem-based situations and more so, reflection. Reflective learning gives rise to moral and ethical dilemmas. However, the professional ethics code of conduct provides a guiding framework. In the UK, the Nursing and Midwifery Council is responsible for creating the guidelines. To large extent, these guidelines cover autonomy and accountability in nursing and legal and ethical principles that underpin nursing practice (Mallik, Hall & Howard 2009). These guidelines also apply to nursing instructors despite the fact that the instructors also train learners on the same. This cements the claim that ethics and moral concerns. As such, instructors are bound to train learners on how to respond to various situations from varying circumstances. Freire (1998) cited in Rideout (2001, 14) discusses this by saying that; To know how to teach is to create possibilities for the construction of knowledge rather than to engage in simply a game of transferring knowledge…in other words, I ought to be aware of being a critical and inquiring subject in regard to the task entrusted to me, the task of teaching and not transferring knowledge. Teachers therefore should not just transfer knowledge but should allow learners to learn through their own experience. Reflective learning is one of the best ways. However, given that the learners are learning through experimentation, they are bound to make mistakes which may contravene the profession and ethics code in nursing. Use of case studies is highly recommended in teaching nursing ethics by many scholars as they foster an in-depth analysis, application of concepts and theory, insight development and creativity (Young & Paterson 2007; O’Connor 2006; Lowenstein & Bradshaw 2004; Rideout 2001). Case studies provide opportunities through which students can relate theory with practice. They also allow students to employ their cognitive skills by assessing the ‘whole picture’ scenario that is developed through the cognitive theory of learning. Traditionally, case studies are presented in brief narratives but differ from the narrative or lecture in that they provide a closed set of information for which to work with. Students are discouraged from employing contextual information or any other points of view (Young & Peterson 2007) This makes such traditional case studies redundant when it comes to cognitive theory which encourages learners to employ contextual information in a holistic manner as per the cognitive theory. This bars them from making use of additional information necessary in taking an appropriate course of action. It is imperative to note that there are other ways that case studies can be employed to draw forth the relational and contextual aspects of knowledge and experience and that are more consistent with the that narrative approaches suggested above. A case can either enhance of promote the learners ability to see relevant contextual meaning and experience beyond the objective facts. In ethics, majority of the objectives facts are provided for by the professional code of ethics enforced by relevant bodies and the law such as the bill of rights. O’Connor (2006) says that it is the responsibility of the instructor to include diverse information in theoretical case studies while on the on the job learning and experience should be varied to give the deepest level of knowledge and the most involving amount of experience. Young and Paterson (2007) note that the usefulness of case studies rests with educators. The authors note that some educators may reduce a case study to a discussion of facts and alternatives while another educator may use the same case to encourage deeper exploration on part of the students and the educator. The learner here engages his or her cognitive skills to identify and connect interrelationships of bits of information provided in the case to come up with an appropriate course of action. One area of nursing ethics that deserves special mention is communication skills. Provision of protocol for communication skills for nurses, either in theory or practice is very hard given that patients or other actors in any form of communication play an active role and have the capacity to influence and direct the communication as active participants. Such situations call for first hand experience of the learners as they touch on personal aspects and the context. Bowles, Mackinstosh and Torn (2001) allege write that although nursing communication skills are often taught, there not many theories to provide a framework for doing so. Again, the effect of such training is hardly evident in practice. They blame this to lack models or clinically credible educators and the nature of skills being taught. For instance, the authors note that some scholars suggest ‘empathic ability’, development of counselling skills’ and ‘active listening’ as effective ways of gaining communication skills though they do not offer techniques to go about it. The authors thus suggest a technique they call Solution Focused Brief Therapy (SFBT). The SFBT was developed in the 1980’s in the US aimed at encouraging individuals to change and adapt and grow. This theory aims at helping practising nursing learners to apply learnt aspects and ideas in ethics and communication skills. The difference between this theory and other models is its strength-oriented approach. This approach seeks to engage the patient in communication that shifts attention form the problem dominated perspective to a solution dominated perspective. The kind of technique is closely related with counselling where assuming that nurses are expected to act as counsellors and therapists (Bowles, Mackinstosh and Torn 2001). The counselling aims reinforcing the strengths, abilities and hopes of the patient. A good example would be a conversation between a nurse and cancer patient. In this case, it can be presumed that the patient is facing a low moment in life while the nurse is supposed to encourage the patient and uplift his spirit which is critical in the healing process. Using the SBFT theory, a nurse will disclose the condition of the patient regarding his cancer but direct focus on the positive side. For instance, the nurse could talk about the future plans of the patient once fully recovered. For admitted patients, such discussions could revolve around activities that the patient can engage in once they leave the hospital. The nurse in this case should be allowed to use her cognitive abilities to ascertain the comfort of the patient with the discussion and the impact. Such discussions should be reflected over and over again and through experiencing that knowledge the leaner learns on the job. Conclusion All in all, it is apparent that nursing education is closely tied to education in general. Education theories are applicable in teaching and learning nursing. As shown by the discussion above, it is apparent that the competence of nursing teachers does not lie in their depth of knowledge in the practice and theory of nursing but in their ability to let their students self educate. This is only possible by creating opportunities that allow them to discover what they have learned from the knowledge that they receive from their instructors. The cognitive theory thus shows that the competence of an instructor in nursing cannot be transferred to the learner if the cognitive abilities of the learner are not well tuned to learn. As such, a competent nurse is a product of his cognitive abilities which the instructor should always aim to nurture. References Bevis, E. (1989). Curriculum building in nursing: a process. London: Jones & Bartlett Learning Billings, D. & Halstead, J. (2005). Teaching in nursing: a guide for faculty. London: Elsevier Health Sciences Bonnel, W. & Smith, K. (2010). Teaching Technologies in Nursing and the Health Professions: Beyond. New York: Springer Publishing Company Bowles, N., Mackintosh, C. & Torn, A. (2001). “Nurses' communication skills: an evaluation of the impact of solution focused communication training” Journal of Advanced Nursing, 36(3), 1-8 Butts, J. & Rich, K. (2010). Philosophies and Theories for Advanced Nursing Practice. London: Jones & Bartlett Learning Lowenstein, A. & Bradshaw, M. (2004). Fuszard's innovative teaching strategies in nursing. London: Jones & Bartlett Learning Mallik, M., Hall, C. & Howard, D. (2009). Nursing Knowledge and Practice: Foundations for Decision Making. London: Elsevier Health Sciences. O’Connor, A. (2006). Clinical instruction and evaluation: a teaching resource. London: Jones & Bartlett Learning. Rideout, E. (2001). Transforming nursing education through problem-based learning. London: Jones & Bartlett Learning Young, L. & Paterson, B. (2007). Teaching nursing: developing a student-centered learning environment. Brisbane: Lippincott Williams & Wilkins Read More