Nuggets of Wisdom
It is valuable where knowledge is advancing rapidly
"I will not leave you comfortiess. I will come to you",
John 14:18
CHAPTER VII
TEACHING STRATEGIES AND
METHODOLOGIES FOR TEACHING AND
LEARNING
A Traditional Teaching Strategies
I. Lecture
Lecturing is a highly structured method where the
teacher acts as the resource person and transmitter of
knowledge / information to learners.
It is the oldest teaching method which was widely used
in the olden times. Students had to depend largely on
the instructor's lecture and it was not after the
invention of the printing press and books became
available that lectures were used to reinforce and
supplement reference materials and textbooks
(Tornyyay, 1987).
Etiology: derived from the greek word «lectura" which
means to read".
Very effective method to impart knowledge in the lower
level of the cognitive domain
Purposes of the lecture method:
1. It is an efficient means to introduce learners to new
topics and placing the topic into the perspective of what
is already known.
2. It is intended to stimulate students' interest in a topic
or subject by pointing out how the facts apply to the
lives, work or occupation of the listeners or students
3. It can inspire people to apply or emulate the worthy
personalities or information that were conveyed in the
lecture
4. It helps the student to integrate or synthesize a large
body of knowledge from several fields or sources more
readily from the lecturer as he brings with him a wealth
of knowledge & experience which is not possible for the
student to acquire by merely reaching the textbook.
5. it can clarify difficult portions especially when
supplemented by graphics, charts, audiovisuals.
6.
and up to-date textbooks are not available especially if
the lecturer in a clinician working in an area of specialty.
Advantages of the lecture Method:
1. It is economical, which is its greatest advantage,
since formal lectures are just as effective whether
the class is 20 or 200 (limited only by classroom
space)
it is also economical in terms of student time, there is
more that could be learned in one hour than reading a
textbook & locating other materials to enrich the lesson
which the lecturer already has
2. The lecturer can enhance the textbook by enriching
a topic & managing it come to life with his wealth of
personal experience & enthusiasm for the subject;
3. During a lecture, the teacher serves as a role model
for student as an authority on the subject, an expert
in the field of learning who demonstrates "critical
thinking" and problem-solving; students are able to
watch a "creative mind at work";
4. An advantage of this one-way verbal
communication is that it helps students develop
their listening abilities. They are disciplined to listen,
remember, track arguments, know when to take
down notes and relate what is being said to the
assigned reading
Disadvantages of lecture method:
1. It places learners in the passive role of a sponge, just
there to soak up knowledge;
2. Few teachers are good lecturers & therefore cannot
achieve class objectives by the lecture method; much
less serve as good role models. Those who become
educators themselves often fall into the same bad
habits.
3. An anecdote of cartoon as described By Zachry (1985)
clearly illustrates the most common disadvantage of the
lecture method.
The teacher was telling her students: "Okay class, my
job is to talk and your job is to listen. If you finish first,
let me know"
***This is the educators' concern… that because
students are passive listeners, they “tune out” before
the end of the class and miss important information.

TEN IMPORTANT POINTS ABOUT LECTURING (Lowman,
1984):
1. Fit the lecture material to the available time
2. Express concepts in the simplest possible way and
define technical terms when using them.
3. Begin the course or class by arousing the students'
interest expressing your expectations positively and
sharing the formulation of the course/class objectives
with the students.
4. Follow a prepared outline but deliver the lecture with
spontaneity injecting improvised material or
illustrations where these are needed in the lecture.
5. Use different methods to prevent monotony and
boredom
6. Develop a varied and interesting teaching style
consistent with your values and personality.
7. Give students enough time to digest the contents of
the lecture and ask questions.
8. Conclude the lesson by connecting what was taken up
today to what will he covered during the next meeting.
9. Be guided by your students during the lecture by
tuning in to their reactions or feedbacks and modifying
your approach when needed
10. Observe good interpersonal relationships with pour
students by remembering that all of you are primarily
persons and secondarily, students and teacher.
ORGANIZING THE LECTURE
Three parts of a lecture are:
1. INTRODUCTION
- An effective introduction delineates specific topics/
subtopics that will be covered.
Example: "Today, we will discuss nutritional anemia
affecting lactating mothers and the signs and symptoms
that are manifested. We will define the probable causes
and identify the rich sources of vitamins and minerals in
the food group which will prevent or correct this
problem. Likewise, we will discuss what will be its
adverse effects on the mother and the baby if left
untreated"
- Provide an outline which can be written on the
board or shown on an overhead projector before
the start of the lesson to help the student. This will
also assist the teacher to avoid repetitions, gaps in
the presentation or omission of important
information.
- Specify ground rules like entertaining questions at
the conclusion of the lecture or at the end of each
segment or subtopic of the lecture.
2. THE BODY OF THE LECTURE
- There should be logical flow of information from
one point to another.
- Avoid including too much material in the lecture to
prevent a rambling presentation and giving the
audience the impression of being unprepared.
- The teacher should be sensitive to the feedbacks or
reactions of the students especially to non-verbal
cues that may indicate boredom, lack of
understanding or daydreaming. Institute corrective
measures or techniques that will awaken the
"slumberers" or activate their involvement and
interest.
- Maintain eye contact and exude warmth,
enthusiasm and motivation to effectively and
efficiently deliver the lecture.
3. THE CONCLUSION
- This deals with the achievement of closure or the
successful termination of the lecture which is
attained when the major principles and objectives
of a lesson or course have been achieved, by linking
new knowledge to past knowledge and creating a
cognitive link or bridge to future learning.
- Closure provides students with the needed sense of
achievement.
- Instructional vs. cognitive closure: Instructional
closure is reached when the class is completed and
the tr has shown the link between past knowledge
and new knowledge
- Cognitive closure is reached when the student has
reached closure and makes the link between old
and new knowledge
- Cognitive closure provides the more relevant
learning goal. Following Blair's (1948) principle that
learning proceeds more rapidly and is retained
much longer when the material learned has
meaning, organization and structure
THREE APPROACHES TO HELP STUDENTS TOWARD
CLOSURE:
1. Review and summary-
- the teacher must listen to the students' reactions
and comments in order to summarize succinctly
(concisely or briefly) and give the students a
capsule (short) summary of the salient points that
were given by the group.
2. Application of what has been learned to similar
situations.
- To help students organize new ideas, the teacher
can cite similar situations where previously learned
materials are applied to new situations and
generalizations are extracted from specific aspects
of the topic.
3. Extend what has been learned to new situations
- this refers to transfer of knowledge from one
situation to another.
Transfer of learning- may be the most significant
criterion of learning
 It refers to the extent or degree by which
knowledge and abilities learned or studied in one
situation are applied to a new or different situation.
 Transfer occurs when the learner recognizes the
similarity between the learning situation and the
transfer situation; learning experiences with
"identical or similar elements" help students to
generalize (give wider use to something: to use
something in a wider or different range of
circumstances, or be used in this way) to new
situations,
 Transfer will occur to the extent that students
expect it to occur.
The use of audiovisual aids are adjuncts (add-ons) which
aid or assist in making learning easier.
Examples are chalkboards where drawings, illustrations
or diagrams are made; overhead projector, slide and
film strips; motion pictures and television; and,
handouts.
Il. Discussion
a. Group Discussion- is formed when more than two
persons are gathered to discuss or resolve an issue,
problem or idea under the guidance of one of its
members.
The larger a group is, the less it can accomplish. The
ideal number for nursing seminars is 10-20 students. In
a large group, students take their turns and sometimes
these needs are not met because of the lack of time. In
small groups, participation is fairly equal among
members.
Coming from a large group discussion, students can be
broken down into smaller groups or sections to be
facilitated by their own section instructor so that gray
areas or muddy points can be clarified and further
discussed.
b. Group conferences, following clinical experiences,
also known as post clinical nursing conferences,
enable students to compare notes and experiences
and may even help each other in identifying
alternative ways of solving nursing problems.
Purposes of Discussion. (De Young, 2003)
a. to give learners the chance to apply the principles
and concepts of previously introduced body of
knowledge and to transfer this knowledge to new
situations;
Example: After the student nurses have attended a
lecture on the care of the newborn, they will come
together to discuss how they can adopt some of the
procedures to the existing facilities in their base
hospital.
b. to clarify information and concepts or what may be
termed as "muddy points" in the discussion with
explanations from the instructor:
C. to enable the students to learn the process of group
problem solving by being members of subgroups which
will discuss the assigned subtopics and then work
together as one group by collating, analyzing, critiquing,
synthesizing and evaluating the totality of the outputs
of each subgroup, drawing on the strengths and
expertise of each other.
Topics dealing with controversies, human interest,
clinical or professional problems and issues usually
result to lively discussion sessions.
Discussion techniques:
a. Properly instruct your students on what they should
do, see, or read so that they can effectively participate
in the forthcoming discussion;
b. Set the ground rules like time limit and decorum of
the participants related to good manners and right
conduct;
c. Physical arrangement like setting the chairs in a circle
will allow for better communication, more eye contact,
participation and better hearing.
d. Plan a discussion starter which will set the mood and
tone of the discussion or "get the ball rolling". The
instructor may pose a question or resort to
brainstorming to elicit topics for discussion. In
brainstorming, the students can say whatever idea
occurs to them about a problem,
Four Discussion Leadership Skills To Keep The
Discussion On Track:
1. Focusing is concentrated effort or attention that is
given to a particular task or thing. Good leadership skills
prevent the group from straying or wandering from the
original issue or task on hand.
Questions may be open-ended which gives focus to the
task on hand like "Why do you think patients miss their
post- operative check-ups?
2. Refocusing is redirecting the group' attention- "Let's
go back to the issue on hand"
3. Changing the focus- when the topic has been
sufficiently discussed, it is usually time to shift to
another subtopic by saying, "Now that we have
discussed the social implications of unwanted
pregnancy, what can be the other issues that will impact
on a woman's health and well-being due to unexpected
pregnancy"?
4. Recapping- is giving a brief summary (outline) of what
the group has done. Its purpose is to lift out or zero in
on ideas to make them more understandable to the
members, set a clearer perspective, establish
relationships among the concepts and make
conclusions.
Eaton, Davis, Benner (1977) identified 11 teacher
behaviors which serve to impede or inhibit student
participation during discussions. These they termed as
discussion stoppers.
WHAT TO AVOID: THE DISCUSSION STOPPERS
1. Insufficient wait-time - teacher is too impatient and
does not give the students sufficient time to
think....teacher answers the question himself/herself,
rephrases the question or gives additional information
to the question.
2. The rapid reward- too rapid acceptance of a correct
response or too forceful reinforcement can prevent
other students from expanding on the answer or inhibit
them from giving other possible answers.
3. The programmed answer- trying to put words or
ideas into the student's mouth would elicit a negative
reaction since it is obvious that the teacher already has
an answer in mind. An example would be, "Don't you
think that euthanasia would be unacceptable to
Filipinos"?
4. Nonspecific feedback questions are vague, global,
diffuse questions that do not foster discussion and does
not diagnose the problem like "How will euthanasia
affect Philippine Society"?
5. Teacher's ego-stroking - teachers who act as the
ultimate authority or who do not appreciate student's
observations and views inhibit discussion.
6. Low-level questions - questions that require facts or
information would end the discussion whereas
questions requiring answers using synthesis, analysis or
evaluation would foster discussion because they
encourage creativity and critical thinking skills.
7. Intrusive questioning involve questions that invade
or trespass into a person's privacy and which the
student may refuse to answer or discuss.
8. Judgmental response to student answers - when the
teacher incorporates her Own values when appraising a
student's answers especially when the teacher is not
aware of the social and cultural context of the learner.
9. Cutting students off by stating that the problem will
be discussed in a later lesson or saying that there is not
enough time to tackle the issue. Being able to refocus
the discussion in a positive and non-threatening manner
is a skill that every teacher needs to develop.
10. Creating a powerful emotional atmosphere and
then ignoring feelings and responses - this happens
when discussing emotionally charged issues and the
teacher is insensitive to the feelings.
IlI. Questioning
Questioning what teachers reed to give and what they
need to ask form an important facet of teaching
strategies. If the development of students' autonomy in
thinking is an important objective, the "seeking"
functions of teaching assume a greater importance than
those of "giving". In order for students to develop
concepts by their own efforts, teachers must become
guides to the questioning process (de Tornyay, 1987).
Questioning is a situation where the teacher is probing
or inquiring from the student as a feedback mechanism
to find out if they have already grasped or understood
the lesson or the matter being discussed.
Types of Questions:
1. Factual or descriptive questions- are questions that
can be answered from memory or by description. It
requires the student to recall previously learned facts or
information.
Example: What are the parameters being measured in
the APGAR scoring of a newborn?
The factual question deals with the who, what, when or
where which provide the building blocks on which
concepts and generalizations are based.
The descriptive question usually elicits simple
descriptive (expressive, telling, informative or
enlightening) statements where longer answers are
required.
Example: What are the differences in the signs and
symptoms of a person in diabetic coma and one who is
experiencing insulin shock?
2. Clarifying questions – are illuminating, revealing,
informative or enlightening questions which can be
done in five ways (Far Western Laboratory for Research
and development (1969):
a. Asking clarifying questions for more information or
more meaning
Example: "Tell us more about the statement you just
made" or "What do you mean by the term______?*
b. Requiring the student to justify (give an explanation
or a reason) response to increase the student's critical
awareness.
Example:
What are the reasons for the assumptions that you
made?" or "Why are you in favor of a parliamentary
form of government?*
c. Refocusing the student's attention where the teacher
may ask a student to clarify or explain a different but
related issue.
Example: "What are the implications of home care to
patients who are undergoing rehabilitative therapy?" or
"How does the statement made by Susan relate to what
Lily just said?"
d. Prompting the student like suggesting or giving a hint
or reminder.
Teacher: You said that turning the patient every two
hours will help prevent the formation of decubitus
ulcers. What is the rationale (underlying principle or
reason) for that?
Melissa: This will relieve the pressure especially from
the bony prominences.
Teacher; That's true. And, if pressure is continuously
applied to these areas, what would be the result?
Melissa: This would deprive these areas of the blood
supply that will nourish the surrounding tissues and
would lead to oxygen deprivation which will eventually
result to necrosis.
e. Redirecting the question so that other students may
participate in the discussion,
Teacher: Melissa said that necrosis is one of the
possible causes of decubitus ulcer formation. Could you
give another contributory factor, Glaiza?
4. Higher-order questions - prod, urge or stimulate
the student to establish relationships, compare and
contrast, make inferences (logic, reasoning or
judgment) rather than merely defining them. This is
a step towards the development of critical thinking
skills and the question "Why" is almost always
asked and the student is expected to generalize,
infer, classify or conclude instead of just giving a
factual answer.
Specific Factions of higher-order questions:
1. Seek or obtain an evaluation (assessment or
appraisal) - these evaluative questions deal with
matters of judgment, value and choice.
Example: Should euthanasia be made part of the law of
the land?
2. Seek or search for inferences (ideas or
suppositions based on facts or premises) where
newly acquired knowledge is related to
something which was previously learned.
Inferences involve either deduction or
induction.
Deduction is a conclusion drawn from a generalization
or principle and applied to a specific situation.
Example: Deductive question: "People react in different
ways to dying. What were some of the mechanisms that
your patient's family adopted to cope with your
patient's impending (forthcoming or approaching)
death?"
Induction requires the students to derive the
generalizations or theories and concepts from a
collection of examples or specific data.
Example: Inductive question: "What can you generalize
about the nursing needs of all these pediatric cancer
patients who were assigned to your group?"
3. Seek comparisons- comparison questions help
students establish whether ideas are related or
unrelated, similar or dissimilar or if they
contradict each other. Compare and contrast
are the words most often used for these
questions.
Example: "What is the relationship between
breastfeeding and lactational amenorrhea?- or
"Compare type A with type B diabetes"
The ability of teacher to ask higher-order questions is
illustrated by the findings of studies which showed that
98.9 % of the total number of questions asked in the
clinical area by nursing instructors and students were
lower-level questions. (Scholdra and Quiring, 1973).
Implication to nursing education: The development of
the higher level cognitive skills like analyzing,
synthesizing and evaluating cannot be accomplished if
instructors ask mostly low- level questions.
In another study, Craig and Page (1981) concluded that
in-service education will improve the nurse instructor's
ability to ask higher-level questions in conducting post
clinical conferences and that mere recitation of
descriptive data of the patient's diagnosis, medication
and treatment should be discouraged but instead make
the students go into analysis, synthesis and evaluation
of the data gathered.
The educational use of questioning as an effective
strategy was studied by Wenk and Menges (1985) which
showed that only a small portion of class time was spent
in asking questions by students and instructors and that
questions asked were mostly on the lower levels of
cognitive learning like memory and recall.
If the development of critical thinking skills is the focus
of nursing as a science and profession, then the
instructors should become motivated to develop their
higher-order questioning skills
IV. Using Audiovisuals
Using Audiovisuals can greatly enhance teaching and
stimulate the student's interest and participation
Traditional audiovisual include handouts, chalkboards or
whiteboards, overhead transparencies which present
charts, graphs, illustrations; slides, videotapes,
DVDs/VCDs
In selecting the appropriate media or medium, the
instructor should be guided primarily by the learning
objectives. The choice is also affected by the availability
of the materials, equipment and technical know-how or
assistance. The learners' characteristics, abilities, and
size of the class should also be considered.
V. Interactive lecture
is a mixture of lecture and audiovisuals. The effectivity
and efficiency of the traditional approaches to teaching
will depend on the instructor's creativity and
resourcefulness.
A class running from four to eight hours per meeting
may be regarded as an ordeal if the teacher will make
use only of the lecture method.
An example would be a combination of lecture/
discussion of the pathophysiology of the disease, film-
showing or videotape of the procedure like giving post -
operative care to a patient who has just undergone
open-heart surgery and board work for the students like
writing a teaching plan or an NCP for the post-op needs
of the patient which the group will discuss and the class
will react to or make a critique of. At the end of the four
or eight hour period, the students and the teacher alike
enjoy the lively and active learning experience which is
made more interesting and entertaining by the proper
use of these audiovisuals and the lecture method.
B. ACTIVITY-BASED TEACHING STRATEGIES
These teaching strategies focus on the learner as the
active participant in learning and include cooperative
learning, simulation and games, case studies, problem-
based learning and self-learning modules which result
to greater retention of knowledge and higher
comprehension rate (De Young, 2003).
I. Cooperative learning- is a system of learning where
the members of the group are aware that they are not
only responsible for their own learning but also for the
learning of others (Lindaner & Petrie, 1997). It involves
structuring small groups of learners who work together
toward achieving shared learning goals.
Types of Cooperative Learning Groups
These three types differ in their length of existence and
the specific purposes they address (Johnson, et.al,
1998).
a. Formal groups- are usually most effective or useful in
the academic or classroom setting than in-service or
patient education departments. An example is the
Nursing research Course where groups of students are
assigned to develop a thesis proposal. Usually, what is
given is a group grade.
b. Informal groups- can be used in any setting, even in
the community. After discussing the topic, the learners'
group can be broken into smaller groups so that they
can discuss what was just learned. An example is a
mothers' class receiving lecture on proper care and
handling of the newborn.
C. Base cooperative learning groups- could be most
applicable to preceptorship programs or new staff
orientation.
II. Simulation (Cooper, 1979; Rockler, 1978; Thiagaran &
Stolovich, 1978)
- is an imitation, recreation or representation of the
structure or dynamics (change-producing forces: the
forces that tend to produce activity and change in any
situation or sphere of existence) of a real thing or
situation with which the learner actively participates
and interacts with persons or things in the environment,
applies previously learned knowledge to solve a
probiem or situation and receives feedback about his or
her responses without fear of adverse effects related to
real-life consequences or results.
Formal Groups
PURPOSE: To complete a specific learning task
consisting of concepts or skills
LENGTH OF EXISTENCE: One class to many weeks
Informal Groups
PURPOSE: To enhance understanding of a specific unit
of information; to make connections to prior learning.
LENGTH OF EXISTENCE: No more than one class and
perhaps for only a few minutes during a class
Base Groups
PURPOSE: To provide encouragement and to monitor
progress throughout the learning experience
LENGTH OF EXISTENCE: Usually long-term learning
experience.
Example: The use of virtual models in Nursing Arts
laboratories where students can learn and/or practice
psychomotor skills without risking damage or injury if
the model were a real live person, like in administration
of intramuscular injections. It is now being widely used
in nursing schools
Examples of simulation: role-laying, practice of skills
(return demonstration), simulation games and clinical
simulation.
 Game- Any event or activity conducted in
accordance
with rules that involves varying degrees of chance or
luck and one or more players who compete (with self,
the game, one another or a computer) through the use
of knowledge or skill in an attempt to reach a specifled
goal (gain an intrinsic or extrinsic reward).
Unlike simulation, many games bear little resemblance
or similarity to actual life situations
Educational Uses Or Simulation And Gaming In Nursing
Education:
1. In using the simulation game "Mental Hospital",
Laszlo & McKenzie (1979)found out that the
participating hospital personnel who experienced being
“mental patients" developed greater sensitivity toward
the patients and increased awareness about patient
rights.
2. Godejohn, et. al., (1975) found out that two
simulation games produced significant decreases in
authoritarianism and social restrictiveness scores on a
scale measuring opinions on mental illness. Based on
these results, they concluded that simulation games can
change attitudes towards mental illness.
3. In community nursing, Shaffer and Pfeiffer (1980)
found out that the students expressed preference for
using videotaped simulations of critical incidents and
participated more actively in discussion than those
using written materials only.
4. Simulation and gaming techniques that increase the
concreteness (able to be seen or touched because it
exists in reality, not just as an idea; definite, certain and
specific rather than vague or general) of the learning
experience should prove most productive for nursing
students.
Types of Simulation (Maatsch and Gordian, 1978):
a. written simulation- paper and pencil presentation of
actual problems or cases where the student makes a
decisions as if doing an actual performance in the
situation. Feedback is given for each decision made and
the effects of the action which is incorporated into the
next decision.
The best example is the Patient Management Problem
(PMP) which is a branched programmed activity
simulating the decision-making process for use in
medical education and licensure (Hubbard, et al., 1965)
and which was first introduced to nursing education by
de Tornyay (1968) with the “simulated clinical nursing
problem test". The PMP can be used either for teaching
or evaluating problem-solving skills and decision-making
in the clinical area.
b. Role-played simulation- is a simulation technique
where one person portrays the role of another whose
primary purpose is to help participants and observers
obtain insights into the behaviors and feelings of people
who are different from themselves by spontaneously
acting out roles involving problems in human relations.
Mechanism of Role-plays (de Tornyay, et.al, 1987):
* Role-plays usually last from 5 to 15 minutes.
* Upon termination of the play, the participants are
asked to discuss their feelings about the roles they
played and the feelings that the roles generated
* Then the observers are asked to join in the discussion
and to analyze what occurred, what feelings were
generated and the insights that were gained
* Criticism should focus more on the role that was
played and the problem that was presented rather than
on the person playing the role.
* Videotaping is highly recommended for precise recall
of the incident to aid the analysis and discussion.
c. Mediated simulation-This uses audio and/or visual
media to present a problem, case, task, or an aspect of
an interpersonal encounter.
1. Videotaped simulation- of clinical situations,
interviews, or illustrating interpersonal relationships.

2. Electronic reproductions include audio reproductions
of human cardiac and respiratory sounds especially for
those learning the basic and advanced physical
assessment skills and for monitoring various body
processes like fatal heart tones during pregnancy and
labor.
3. Physical simulators- includes the use of three.
Dimensional lifelike models or parts of the human body
to teach or evaluate specific clinical skills like enema
administration, urinary catheterization,
cardiopulmonary resuscitation, and colostomy care. An
example is "Mrs. Chase", a model which allows the
students to practice bed baths and positioning. The
intravenous (IV) injection arm, a more sophisticated
model, is used to do venipunctures, IV injections, and
administer IV fluids and provides a more realistic
experience because of the "blood" return and the
opportunity to actually inject fluids into the simulated
veins.
d. Computer simulation- uses a computer to present
cases, provide information requested by students,
incorporate decisions made, and give feedbacks
regarding effects of the decisions.
III. Case Studies (DeYoung, 2003) -
is an "analysis of an incident or situation in which
characters and relationships are described, factual or
hypothetical events transpire, and problems need to be
resolved or solved"
* Case studies provide learners with an "open-ended"
problem where the student is expected to see the pros
and cons, advantages/disadvantages of the presenting
alternatives or options where there is more than one
desirable outcome. After comparing the alternative
solutions, the student must be able to make a decision
and defend or justify the choice of actions.
 The student's ability to see and appreciate more
than one perspective or point of view is one of the
primary objectives of case studies.
1. Develop the objectives based on what you expect the
students to achieve.
2. Select a situation, topic or scenario that will meet
your objectives and learning content you have chosen.
Draw cases from real-life situations
3. Develop the characters by giving enough details
about the patient and his/her family and health care
providers so that the interpersonal aspects of the case
will be an integral part of it.
4. Develop the discussion questions which should
promote application of principles and generation of
possible interventions and outcomes.
5. Lead the group discussion and keep the atmosphere
of the class relaxed. Whether this is a group or
individual case presentation, Explain to the class that
except for the factual questions, there is no one right
answer to a case.
IV. Problem-based learning (PBL) - is an approach to
learning that involves exposing the students to real-life
problems and working together in small groups,
analyzing the case, deciding what information they need
and then solving the problems.
 It is similar to a case study method but differs in
that the students using PBL have very little
background knowledge or information about the
case and only obtains much of the learning content
as they go along solving the problem.
 Develops the student's ability to analyze, criticize,
synthesize and evaluate in order to manage the
problems found in the clinical area where the
learners, working as a team, look for the
information, analyze how this will help in solving
the problem, make decisions, use evidence to
support their conclusions and implement other
critical thinking skills.
 Unlike in the traditional method, learning of the
content or lesson is done when it is needed by the
students to solve a problem, not when the teacher
thinks they need to learn it.
 The teachers act as expert resources who assist the
students on a "need basis"
V. Self-learning Modules- are also called self-directed
learning modules, self-paced learning modules, self-
learning packets, and individualized learning activity
packages.
- It is defined as a self-contained unit or package of
study materials for use by an individual (De Young,
2003)… most useful for audit learners in graduate and
undergraduate levels.
Components of Seif-learning modules:
1. Introduction and instruction:
- The topic for a module is a single concept... A course
may have several modules.
2. Behavioral objectives- state what the learner will be
able to do upon completion of the module.
3. Pretest- usually but not always included but modules
for staff development and academic settings usually
inclade pretests.
4. Learning activities
5. Self-evaluations
6. Posttest
VI. Critical thinking approach views learning as a shared
responsibility between the teacher and the learner.
Learners are empowered because they have control of
the learning process and in this set-up, the teacher acts
as a mentor (advisor, counselor or guide) and facilitator
(catalyst or somebody who initiates an activity Or makes
change happen; means, medium)
Critical thinking has been defined in many ways but the
most widely accepted is by Watson & Glaser (1964 who
described critical thinking as
 “A composite (something composed of different
parts) of attitudes of inquiry; knowledge of the
nature of valid inferences, abstractions and
generalizations; and skilis in employing and applying
these attitudes and knowledge.
 It also involves one' frame of mind or attitude and
is a perspective through which one views all
situations.
In the year 2000, a panel of nursing experts formulated
a definition of Critical Thinking in Nursing Practice which
states that, "it is a discipline specific, a reflective
reasoning process that guides a nurse in generating,
implementing and evaluating approaches for dealing
with client care and professional conceras (National
League for Nursing, 2001).
While it is true that developing critical thinking skills is
one of the major thrusts of nursing education, the
clinical instructor may wittingly or unwittingly, he guilty
of inhibiting the development of this skil.
Some of the practices we need to STOP DOING are:
1. Stop monopolizing the class but allow the students to
ask questions or ask them questions that will require
their use of the higher levels of cognition.
2. Avoid the "must fully cover" mentality where in your
effort to cover as much of the content as possible, you
live no time for the students to fully understand and
"digest" what they are supposed to be learning.
Strategies That Enhance Critical Thinking
1. Discussion- the highest level of discussion is when
the teacher and student or the students, among
themselves, engage in animated or lively discussion. The
best scenario is when the teacher plays the role of an
observer and only comes in to prompt the students,
refocus or redirect the discussion
2. Asking effective questions- the high-order level
questioning which requires responses supported by
explanations, theories, evidences or reasons develop
critical thinking and creative skills.
Socratic Method (Paul and Elder, 1995, 1996)
- a way of questioning where the teacher responds to all
questions or comments with more questions. This
constant probing (inquiring or asking) and posing of
thought-provoking questions by the teacher is intended
 to help the student seek to understand various points of
view or perspectives.
 Structured controversy (Johnson and Johnson, 1989;
Pederson, et.al., 1990) - relies heavily on effective
questioning; controversy is deliberately introduced and
used to elicit critical thinking. This is similar to a debate
where two groups argue for and against an issue but
instead of just citing factual information, reasoned
judgment is used so that a consensus that is supported
by evidence is reached. This will be very useful in
assessing different patient care situations
3. Text interaction- The students analyze, scrutinize and
"interact* with the content of the reading materials
instead of just reading the article or textbook.
 The teacher can ask the students to submit their
"text interactions" at the beginning of the class, give
a synopsis (a rundown or summary) or share a part
of his work with his group members
4. Concept mapping (Angelo and Cross, 1993)- involves
drawings or diagrams which show the mental
connections or associations that students make
between a major or central concept that a teacher
focuses on and other concepts that the students have
already learned.
 This technique shows the observable and assessable
record of the student's conceptual schemata which
are mental patterns or diagrams showing the basic
outline or patterns of associations they make in
relation to a central idea or concept.
 The concept map allows the students to examine
their conceptual networks, compare their maps
with their peers and experts and then make explicit
(definite) changes.
 This technique is a very valuable tool to asses and
develop metacognition which is knowing one's own
thoughts and the factors that influence one's
thinking.
Step-by-step procedure in making concept maps:
(Angelo and Cross, 1993)
1. Select the concept that will be used as the stimulus or
the starting point for the concept map. It should be
relevant to the course and relatively rich in conceptual
connections
Example: Concept of self-awareness in relation to
mental health and wellness.
2. Allow the students to brainstorm for a few minutes
writing down terms and short phrases closely related to
the stimulus or the focal concept.
3. Draw a concept map based on your brainstorming,
placing the stimulus in the center and drawing lines to
other concepts similar to a wheel with spokes, with the
focus concept at the hub. It can also resemble the solar
system and the planets with the stimulus la the sun's
position or it may also look like a Geographical nap.
4. After the primary associations have been sketched,
add the secondary and even tertiary levels of
association if appropriate.
5. Determine the ways in which the various concepts
are related to each other and write those types of
relations on the lines connecting the concepts.
6. Prepare a simple parallel example that you as the
teacher can use to illustrate this to the class.
7. Present the example to the students and work
through it with them step-by-step; checking the results
at each step to make the process is clear.
How to turn the collected data into useful information
1. In analyzing the students' concept maps, consider
both the content (the concept) and the types of
relations identified among the concepts. Your own
concept map can serve as the master copy for
comparison and be ready for unexpected creative ideas
from your students.
2. Code the data in a matrix where the degree of
relationship (primary, secondary, or tertiary levels) is
juxtaposed (put side by side suggest a link between
them or emphasize the contrast between them) with
the type of relationship (is it a set/subset, part or whole,
parallel, elements, cause or elect; is it a defining quality
or a necessary condition and so on).
3. After encoding the data, the number of responses in
each cell can be counted and the balance among cells
analyzed.
4. Coding the data on a 3-by-5-Inch index cards or small
slips of paper can make the data easier to manipulate
and rearrange.
5. Have the students use large format graph paper (e.g.,
four squares per inch) so that they can determine and
calculate specific distances between the focus concept
and the various related concepts. Assign the concept
map as a small group assessment project. Ask the
student to write explanatory essays based on their
maps.
 Concept maps reflect current research on cognitive
psychology by directing the attention of the teacher
and the student to the mental maps” that are used
to organize what was learned.
 Because it calls for a graphic (vividly or clearly
detailed) response, this technique favors students
with strong visual learning skills.
 Students with well-honed (well-developed) verbal
skills but less developed graphic skills (presentation
of information in the form of diagrams and
illustrations instead of words or numbers) may And
the concept map frustrating and question its value.
C. COMPUTER TEACHING STRATEGIES
- The role of technology in today's world cannot be
overemphasized. With the recent technological
discoveries and advancements taking place by the
nanosecond, the information highway, via the Internet,
has really expanded and is widely traversed by people
from all nations and inclinations.
This is the period in man's history which is known as the
Information Age where computers have practically
taken over the operation of man's existence from the
mundane (ordinary, everyday) activities of living to the
conduct of world politics, communications, business
and even mankind's survival.
Computers have practically removed the barriers
imposed by time, distance, culture, economics and even
space, to name a few, through the touch of a button or
a screen. In fact, it has been predicted that those who
are computer illiterate will eventually be as helpless as
those who are unable to read and write (Pipes, 1980).
How Have Computers And The Information Age
Technology Affected The Educational Landscape?
The end of the twentieth century saw the birth of
computers, information technology and user-friendly
softwares. The application of this technology in
education has profound effects on the teaching-learning
process.
The Information Age Technology has greatly affected
teachers and learners in all educational settings (Gross,
1999) as shown by:
 the ease with which information is made available,
updated and disseminated makes teaching and
learning more interesting and challenging; the use
of computers as a teaching strategy has mainly
enhanced cognitive learning and mastery of skills
 computers make learning through mastery possible
where the student can continuously use the
computer on a 24/7 (twenty-four hours, seven days
a week) basis or until he or she has thoroughly
learned or mastered the skill or concept;
 computers provide immediate performance
feedback to the learner either to praise a correct
answer or institute corrective measures for wrong
answers.
Definition Of Terms:
1. WWW- World Wide Web- is a network of information
servers around the world that are connected to the
Internet. It was created to display information; it resides
in a small section of the Internet and could not exist
without the Internet's computer network.
2. Internet- is a huge global network of computers
which was established to allow transfer of information
from one computer to another. It was created to
exchange information. It could exist even without the
Www.
3. Web browser- a special software program that
locates and displays web pages like Netscape Navigator
and Microsoft internet Explorer
4. Web page- is a special type of document used by the
servers of WWW
5. Search engines (e.g., Google) and search directories
eg. Yahoo!) - are computer programs that allow the user
to search the web for particular subject area. The Web
is so large that a search engine or search directory will
only be able to cover small percentage of the availabie
web pages (Pandia Coni, 1999).
The Use of Technology in Education and Patient Care
1. There is role reyersal as far as the teacher or
educator is concerned from sole provider or ultimate
source of knowledge or information to facilitator of
learaing by:
 assisting the learner to refine the probiem
 helping the learner And the needed information;
and
 guiding the learner to critically evaluate the
information on band
The nurse educators can focus more or development
and application of critical thinking skills of the students
rather than on memorization and the lower level
learning skills with the aid of the computer;
2. Some schools have adapted virtual reality (something
that is close to the truth), like a program for teaching
venipuncture, and computer simulation in their nursing
arts laboratory. E-nursing is also being used as a mode
of instruction in some colleges of nursing in the
Philippines. Students are being given more
opportunities for hands -on manipulation and
application of skill and concepts. Life-like manikins and
computer exereines accumulating actual life conditions
and responses enable the students to practice
complicated and dangerous skills within the risks
involved in true-to-life settings is safe environment.
3. The learner is given more freedom to explore the
learning environment, design the learning objectives
and content, and avail of more practice the in order to
gain mastery of skills and concepts on a 24/9 twenty-
four hours, seven days a week) basis which is not
possible in the traditional mode of education.
4. The patient or the learner can be taught how to avail
of more information related to his illness and care. By
using the laterst where vitral reality programs that
teach patients with Parkinson's disease how to steady
their
gait and asthmatics on how to take their medications
properly have already been developed and used.
5. The patient-nurse interactive dialogue or exchange of
information and ideas is now being done in most of the
advanced countries where Durges CR interact with
health care consumers anytime, in any setting.
Technology in Nursing Education and Communication
1. Distance Education- means that the teacher and
learner are separated from each other or the student is
not undergoing the traditional classroom education.
 Learning is achieved through online courses with
the Internet becoming the primary vehicle for
delivering distance education;
 Offers a more flexible approach to learning;
 Studies show that there is no significant difference
in the learning outcomes of students enrolled in the
traditional classroom setting and those undertaking
distance education (Russell, 1998)
 Distance learning (Bastable, 2003) is a flexible
telecommunications method of instruction using
video or computer technology to transmit live, on-
line or taped messages between the instructor and
the learner who are separated from one another by
time and/ or location.
Some techniques that are used in distance learning:
 Online courses
 correspondence courses
 independent study, and
 videoconferencing
Due to the technological advances, nursing education is
now using the programs of distance education. Today,
the Regents External Degree Program, now known as
Excelsior College, is one of the largest nursing programs
in the world offering associate, baccalaureate, and
master's degree programs.
2. E-LEARNING is an abbreviation for electronic learning;
an Information Age approach to staff education.
Computer technology is used to provide businesses and
schools with learning experiences anytime, anywhere.
However, most organizations view E-learning as a
complement to instructor-led training and not as a
replacement for it (Sofres, 2001).
 E-learning training modules can be accessed via the
World Wide Web in a computer or laptop within the
clinical unit;
 the modules can be completed within 15-30
minutes;
 E-learning programs can be customized or
personalized to meet the learning needs of the
individual, staff or the organization;
 E-learning modules are interactive and reality-based
where patient simulation can be created to allow
the participant to manage the care of a virtual
patient.
3. Internet- a huge global computer network, of which
the World Wide Web is a component, established to
allow transfer (exchange) of information from one
computer to another...delivers information to people
and grables them to communicate via e- mail, real-time
chat, electronic discussion groups or Usenet
newsgroups (Bastable, 2003).
Strategies that use Computer-assisted Instruction (CAR)
in Nursing (de Tornyay & Thompson, 1987)
1. Tatorial mode
 The simplest form- provides information to the
student in the form of factual statements which are
interspersed (combined with or mixed together)
with predetermined question and answers from the
computer. The computer presents a content
statement or asks a question which the student
must answer. The computer analyzes the response
and decides what material or information to
present. The computer can even be programmed to
coach the student in certain subject areas; it gives
immediate feedback about performance, can
recommend remedial measures and even refer the
student to the instructor in problematic areas.
2. Drill-and-practice- the computer presents a series of
question or problems from previously learned materlal
which the student must answer from recall. This is
based on the principle of mastery through the use of
repetitious practice or rehearsal of knowledge or skills.
3. Simulation (imitation, copy) - The computer is used
as:
 a vehicle or medium to present a copy or model of a
real life situation;
 provide data requested by the student;
 incorporate the student's decision into the system,
and;
 provide the student with feedbacks regarding the
decisions he or she made using the inquiry or
dialogue pattern of communication
4. Games- Both simulation and nonsimulation games
can be used with the computer. The program is
designed to:
 assess strategies
 give results or effects of decisions made
 and introduce variables that alter the course of
events
In nursing, computer games can involve either content
(e.g. drugs and medical terminologies) or process
(developing the nursing care plan for a diabetic patient).
When used with other types of computer assisted
instruction programs, games will provide increased
motivation and novelty in the learning process.
As the world continues its race against time and
distance, and technological discoveries and advances
happen by the nanosecond, one has to accept the
reality that we may just wake up one day like Alice in
Wonderland wondering whether this is still the same
world where we woke up in this morning.
Do not allow ourselves to be "left behind" in a world
whose needs and wants have changed overnight. Nurse
educators cannot continue to be “computer illiterate"
because we owe it to ourselves and our students,
clients, patients and colleagues to be able to maximize
the wonders and utility of the computer and the
information highway via the Internet.
 written or oral tests, return demonstrations, case
studies
 observation, interview, self-reports and self-
monitoring
 journals or learning feedback diaries

D. TEACHING OF PSYCHOMOTOR SKILLS

1. Keep skill instruction separate from the cognitive and

affective behavioral components. Do not interfere by
asking questions which require a cognitive or affective
response while the learner is performing the procedure
as mastery of skills require a great deal of concentration
and focus. Do not ask the learner to demonstrate two
different behaviors at the same time.

 In psychomotor skill development, performing a skill

(which is short-lived or momentary) is not
equivalent to learning a skill (which is more
permanent due to repeated practice and
experience).
 For a successful psychomotor learning, contact with
or supervision by the instructor is a very important
element in teaching nursing students. (Miracle,
1999).
 Initially, motor skills should be practiced first in the
nursing skills laboratory to provide a safe and non-
threatening environment for the novice.

TEACHING METHODS MOST COMMONLY USED IN THE

PSYCHOMOTOR DOMAIN:

 Demonstration and return demonstration

 Self-directed study
 Role-playing, peer teaching

The teaching of psychomotor skills is geared towards

the learuer's actual performance to gain the skills in
performing procedures, treatments or health behaviors
independently.

Methods of evaluation: