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Effective Learning: What Teachers Need to Know Knowing is a process, not a product.

Jerome Bruner (1966) What brings about effective learning in nursing students? y Insight part of the student y Clinical experience y Presentation of information y Structures the learning experience THEORIES OF LEARNING We approach learning individually, based largely on cognitive style (awareness of and taking in of relevant information) and preferred approaches to loearning, or learning style. Some students are aware of their style and preference, some gain insight into these patterns as they become more sophisticated learners, and some students have never been guided to determine how they learn best. Theoretical underpinnings classify learning as behavioristic or cognitive. Skinner and thorndike Learning a change in behavior and used stimulus response actions as an example. Bandura s (1977) theory of social learning - Observation - Imitation - Reinforcement We learn from society, and we learn to be social. This type of learning is evident when we describe the need to socialize students to the profession of nursing. Robert Gagne (1968) y Sequencing of instruction y Condition by which takes place

specific behavioral objectives. Based on his definition of intelligence as the ability to . Gardner s theory of multiple intelligences recognizes cognition as more than knowledge acquisition. and attitudes. and include intellectual and motor skills. moving from simple to complex learning. measurable. cognitive strategies. Use of behaviorism in nursing education was especially popular in the 1970s and early 1980s through the use of concrete. Ausbel s theory relies heavily on the acquisition of previous knowledge. Concept learning 3. Cognitive learning results in the development of perceptions and insight. Cognitive theories address the perceptual aspect of learning. Jerome Bruner (1966) Cognitive learning processes of conceptualization and categorization. The same principles are fundamental to curriculum development based upon transition from simple to complex situation. He contended that intellectual development includes awareness of one s own thinking. and the ability to prioritize. Discrimination learning 2. also called gestalt. 1. These principles are useful for introducing the new student to the heal care environment by relating information to what the student knows about health and illness.y Outcomes of learning or categories These learning categories are based on a hierarchical arrangement of learning theories. Bruner also saw the benefit of discovery learning to bring about insights. that brings about a change in thought patterns (causing one to think) and related actions. verbal information. Ausubel s (1968) assimilation theory Meaningful learning the individual develops a more complex cognitive structure by associating new meanings with old ones that already exist within the learner s frame of reference. Rule learning Gagne s ideas seem to combine behaviorism and cognitive theories. the ability to recognize and deal with several alternatives and sequences.

. Interpersonal 7. 3. 2. Dualism (black vs. Musical/rhythmic 3. white). Visual/spatial 5. Multiplicity (diversity and tolerance). 4.solve problems or fashion products that are valued in more than one setting . Logical/mathematical 4. Intrapersonal Cognitive theories that address learning stages appropriate for college students include Perry s (1970) model of intellectual and ethical development. Gardner has described seven forms of intelligences: 1. Linguistic 2. Bodily kinesthetic 6. Relativism (decision made by reasoned support. This model recognizes four nonstatic stages in which students progress: 1. Commitment to relativism (recognition of value set for decision making). Perry [s ideas can serve to explain how critical thinking is developed over time.

From the early days in the late 1800s through the 1950s. some may be brightly colored. when put together. transparent. but women were often in the majority (Moffat. and those were few and far between. with a large majority of Caucasian (White) and Protestant students in all but the religious sponsored or minority established programs. and were religious and ethnic student quotas in many colleges and universities. Student nurses were the major providers of care for hospital patients. other minorities. aware of trends and patterns. forming new designs and an overall effect very different from the component pieces. each different in size and shape. This meant that most classes were homogenized. while women became nurses. there were very few graduate nurses in hospitals. Other health professions may have had some of each gender. Most graduate nurses moved into private duty after graduation. health care professional education was almost nonexistent for African Americans (Blacks). Health professions educators and leaders have recognized this change. and able to respond to continuing challenges. 2003). and classrooms in the future may look very different. Asian. Immigration. . or with no color added. and provided new and different opportunities and challenges from those of the past. Islamic or Muslim students were admitted to the schools. A mosaic is made up of many pieces. This chapter presents a brief glimpse at some of the diversity issues in the past and present day. the pieces change.Chapter 2 Diversity in the Classroom Today s classrooms are very different from those in the past. Catholic and Jewish hospitals often had their own schools of nursing. both forced and voluntary has shaped the face of this country. Each piece. and cultural competence of practitioners is now being stressed in both education and service. and persons with disabilities. Each new wave of immigrants adds to the mosaic that is the United States. Educators need to be flexible. Change continues. Men went into medicine. Educatinal facilities were often segregated culturally and religiously. with some going into public health and a few staying on primarily in managerial or teaching positions. Those changes shaped the move toward increased diversity of both patients and student body in our world today. Very few Hispanic. THE PAST In the 1950s. and it discusses classroom population. others pale.

One year. very few nursing schools admitted married students. and skilled nurses were needed for those areas as well. During that time. and pregnancy out of wedlock was an unforgivable sin for health professions education. University Hospital had two schools of nursing. The Barrett school accepted more nursing students and had a higther graduation rate than the Lamar school. expansion. from the early 1900s through the early 1960s. excluding pregnant women. but could be welcomed in psychiatric facilities because it was thought that they were stronger and could work better with distraught and violent patients. . In Augusta. and even if they were about to graduate. the Lamar school for Blacks. especially if the secret marriages that occurred were found out by school authorities. and White students with Whites. Disabled students were not admitted to programs due to they cannot participate in providing all aspects of care. The late 1960s and early 1970s brought a revolutionary change. because Nursing was viewed as a woman s profession. In Autusta. which has continued expanding since that time. and the Barrett school for Whites (Lowenstein. Women had more opportunities to be admitted to health care professions that were previously male dominated. more health care professionals were needed. The civil rights movement sparked a feminist movement. and teachers were almost always White. Development of intensive care units was also a trend in the mid-1950s. shortly after World War II. It provided funds to hospitals for renovation. although the numbers were still small. and new hospital buildings expanded. The two schools joined together in 1965. Female students were dismissed from the program if they chose to get married. and often in the North (although no one talked about that). and those movements opened previously closed doors in education. capital projects. 1994). the Hill-Burton Act was passed in Congress and signed into law. administrators. and those who had severe restrictions in clinical experiences such as obstetrics and gynecology. three Asian students applied and were admitted to the Barrett school. as in most of the South. A few men were admitted into programs that had only women students. but only one graduated. Supervisors. after the passage of civil rights legislation.In 1946. Men were scarcely permitted. Few schools permitted married students. Georgia. Black students were assigned to the units with Black patients.

the rules against marriage were dropped. even with the feminist movements of the 1960s and 1970s. During this period of time the community college movement began. and women could attend school while pregnant. Many hospital diploma schools began to close. In nursing. However. However. the American Physical Therapy Association (APTA). especially the belief that male nurses were homosexual. were begun by women. to those who could not afford private college tuition. The board of directors appointed the first committee on women in physical therapy. although that was a prolonged fight. who could then attend less expensive schools that were closer to home. which also contributed to the demise of hospital programs.and discrimination prevalent. the face of the classroom is continuing its transformation. In an effort to raise the status of women in the profession. but were not satisfied. including minority women. The office of minority affairs also became an integral part of the APTA headquarters at that time. It provided more access to minorities. for many reasons. although many attitudes of the past still exist today. but men were recognized in the profession by the 1920s. Part-time attendance was possible in some programs. and discrimination still occurs. it took until the early 1990s for the APTA to feel it important enough to address women s issues and the inequities in the profession as it pertained to the disparities in the professional and economic status of women. . Although the changes have been gradual. and in 1994 an office of women s issues was created at APTA headquarters in Alexandria. The physical therapy profession and its professional organization. the baccalaureate goal was not achieved. nursing leaders recognized the discrimination against women in college and university admissions. Graduates of associate degree programs in nursing were eligible for licensure as registered nurses and took less time to graduate than the typical three-year diploma program students. The sexual revolution of those years also brought a change in thinking about sexual orientation. they began a move toward baccalaureate collegiate education for all nurses by 1984. as the profession tried to recruit more minorities. and those with families. This was a boon to older women. and to students who needed educational facilities closer to their homes. During those years. Virginia. and nursing students no longer needed to live at the hospitals. They were pleased that nursing education had moved out of the hospital program.

Students. although success rates are still low. There are diverse social and family issues in the classroom. Splenser (2003) and his colleagues. This required educators to think differently about what could be done to provide access and retention for disabled persons who would be able to work in some. They also found a positive correlation between increased minority applications and the presence of minority faculty in a program. including children with disabilities. diversity no longer means ethnic background alone. In some places. which can result in discrimination. Although diversity in admissions and hiring may be strongly encouraged. and more women have gone into that field than ever before. although nursing still has a minority of male students. it is recognized that there is still a need to make higher education more accessible for both minorities and students with disabilities. found that when schools provided special retention efforts. However. the Americans with Disabilities Act (ADA) was passed by Congress and signed into law. THE PRESENT The health professions classroom is more diverse than ever before. Those in the sandwich generation may have caretaker responsibilities for both their parents and their children. it worked the other way around. but they often have great responsibility in raising their children alone. Ogunsiji & Wikes. especially older ones. Many divorced and single parents have gone back to school. aspects of their chosen health profession. In medicine. The age range may be wide and gender ratios ma have changed. if not all. disadvantaged students have come into the health professions classrooms as new economic relief programs are put into place (Wessling. and thereby provide a valuable service for the profession and its patients. they were effective in increasing the numbers of graduating minority students. . However. Even thiough affirmative action has been under fire. There is diversity in sexual orientation. in a study of physical therapy educational programs. 2000). 2005. may have caretaker responsibilities for their parents or other relatives. Colleges and universities are being encouraged to promote diversity in both hiring faculty and in student recruitment and admissions.In 1990. and that may interfere with the amount of time that can be allotted to school work (Grosz. 2005). retaining diverse students and faculty is often difficult.

as well as perceived racism can cause academic difficulties. stress. Evans found Hispanic/Latino and Native American nursing students struggled with similar feelings. and eventually failure. but many not be used. it was difficult for them to imagine themselves successful in a health care profession. Minority are often expected to fail. Lack of family support due to financial or cultural expectations and ignorance of academic demands was also identified as a barrier to success for some students. Students who successfully confronted those barriers were helped by faculty who recognized these stressors. . worked to respect students intense obligation to family and community. but often affect other minorities. and provided long-tern. personal encouragement to continue in the program. In many cases support services are offered by institutions.Lack of success occurs in Blacks because they are frequently in the minority in such a classroom. and lack of financial resources can contribute to that failure. Those in the study described the impact of perceived lack of options for minorities. Inadequate academic preparation for the rigors of college. leading to increased anxiety. Even before they entered the program. feelings of isolation. alienation and loneliness. especially those who were the first in their families to attend college. family conflicts. Language issues can be difficult to overcome. Bain (2004) noted that even students who had a strong self-image could fall into the trap of feeling that they needed to prove themselves. as well as White students from poorer economic strata. These issues are not limited to Blacks. Letting minority students know that there is respect for their abilities has been shown to lead to improvement in pass rates.

y Changes in education that brought nursing into academic settings and gave rise to nursing science and nursing research. increased focus on care of the elderly. The field of education has also changed over the years through many of the same forces that affected health care. growth of nursing and rehabilitation services in the military. including. but not limited to: y Appearance of new diseases y War and its consequences. . y Religious issues brought in ethical components of care and development of parish nursing. y Sociocultural issues brought dramatic changes in maternity care from shortened length to stay to sbiling visitation. Todays technology and therapeutics were inconceivable even a few decades ago. and veterans systems. Graduates who are self-directed learners understand and are responsive to health care system changes when they are in practice and out of the school setting. while enabling self-directed student learning. They need to be knowledgeable about changes in practice and technology in both fields. and other health professions have developed and evolved. the growth of the health professions has been influenced by those new technologies and therapeutics. and resources.Chapter 3 Strategies for Innovation The scope of change in health care has been enormous. which brought us Meidcare. and the rate at which change occurs continues to accelerate. Medicaid. They challenge health professions educators to keep on top of the trends. These forces are part of the total environment in which we live and work. and end of life care. where there are no faculty members with whom to consult. managed care. y Changing economics and political/legal issues. Over time. technologies. but there are many other influencing factors and forces. Health care educators straddle the fields of health care practice and education. and legalized abortion.