NUR 6300 Module 1 Learning Theory Paper: Teaching Heart Failure Through Adult Learning, Experience and Clinical Situations Example

From Ninety Slides to One Patient's Week: Rebuilding a Heart Failure Class Around Adult Learning and Experience

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-6300: Theoretical Foundations and Instructional Strategies in Nursing Education

Mentor Name

Month Day, Year

From Ninety Slides to One Patient's Week: Rebuilding a Heart Failure Class Around Adult Learning and Experience

The Class as It Was

The program, the students and the class described here are invented. A pre-licensure nursing program in Bergen County teaches heart failure in its second medical-surgical course. For years the topic has been a two-hour lecture of about ninety slides covering pathophysiology, classification, medications, diet, monitoring and discharge teaching. Students are adults; many work as nursing assistants, some have families and a few have earlier degrees. Exam results on heart failure items are acceptable, but clinical instructors report that students in hospital placements cannot connect a patient's rising weight and new crackles to what they memorized, and cannot explain why a patient is on three different heart medicines. The new course leader, who is studying for her MSN as a future educator, chose to rebuild the class using learning theory rather than trimming slides.

How Adults Learn

Knowles et al. (2015) set out the assumptions of andragogy, a model of adult learning. Before an adult puts effort into learning something, they want to understand the reason for it. They have a self-concept of being responsible for their own decisions and resent being treated as dependent. They bring a large reservoir of experience that is both a resource for learning and a source of fixed habits. Their readiness grows for whatever helps them cope with real situations in their lives. They learn around problems and tasks, not around subjects. And while external motivators matter, the most powerful motivators are internal, such as self-esteem and quality of life.

The old lecture worked against several of these assumptions. It began with pathophysiology before students knew why it mattered, treated students as passive receivers and ignored the experience that nursing assistants in the class had with heart failure patients on their own units.

Learning From Experience

Kolb (1984) pictured learning as a loop through which knowledge is created through the transformation of experience. Learners have a concrete experience, reflect on it from different perspectives, form abstract concepts that explain what they observed and then test those concepts in new situations, which produces new experience. Kolb argued that effective learning moves through all four stages and that people differ in the stages they prefer, so teaching that offers only abstract concepts will reach some learners and miss others.

Teaching for Salience

Benner et al. (2010) reported the Carnegie Foundation's national study of nursing education. They found that classroom teaching often covered large amounts of decontextualized knowledge while clinical teaching gave students rich situations, with little integration between the two. They called for four shifts: from covering abstract knowledge to teaching for a sense of salience, situated cognition and action in particular clinical situations; from separating classroom and clinical teaching to integrating them; from an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking; and from socialization and role-taking to formation of a professional identity. Their recommendation to teach knowledge in the context of particular patients speaks directly to the clinical instructors' complaint.

The Redesigned Class

The new class follows one invented patient, a 72-year-old retired bus driver admitted with worsening shortness of breath, through a week from emergency department to discharge. It begins with a two-minute recorded call from his daughter, played aloud, describing his swollen ankles and the three pillows he now sleeps on, and a question to the class: what would you look for first, and why does it matter? Students who are nursing assistants are asked what they have seen in patients like him.

The class then moves through four short segments, each built on Kolb's cycle. Day one: students see his admission data, discuss in pairs what they notice and then the educator introduces the concepts of fluid overload and reduced ejection fraction that explain those findings. Day two: his weight drops after diuretics but his potassium falls; students decide what to monitor and the educator explains the drug classes and their effects. Day four: he asks why he needs so many pills; students practice explaining each medicine in plain language to a partner playing the patient. Day six: discharge; students build a teaching plan around his daily weights and his favorite salty foods. The slides that remain, now about twenty, support each segment rather than lead it.

A Statement of Teaching Philosophy

The redesign rests on a short philosophy. Students learn best when they see why knowledge matters for a particular patient, when their own experience is welcomed and examined, when they move between doing and thinking and when the classroom feels like rehearsal for clinical practice rather than a separate world. The educator's role is to design situations, ask questions and explain concepts at the moment students need them.

Evaluating the Change

The educator will compare students' performance on heart failure exam items with the previous year's cohort, ask clinical instructors to rate students' ability to connect findings to concepts in their next placement and collect brief student reflections on what helped them learn.

Limits

Following one patient cannot cover every variation of heart failure, and some content moves to assigned reading. Comparing cohorts does not prove that the redesign caused any difference. Students who prefer lectures may find the new class uncomfortable at first.

Conclusion

A lecture of ninety slides covered heart failure without helping students recognize it in a patient. Knowles's assumptions explained why adult students needed a reason and a problem, Kolb's cycle gave each segment a structure and the Carnegie study's call for teaching in particular situations shaped the whole class. The redesign follows one patient through a week and asks students to think, decide and explain as they will in practice.

References

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Jossey-Bass.

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice-Hall.