Nursing Education

Brainstorming can be an effective way to generate ideas on a specific issue and then to determine which idea or ideas is the best solution. Brainstorming is most effective with groups of 8 - 12 people and should be performed in a relaxed environment.  It works best with a varied group of people.

There are various approaches to brainstorming.  The traditional method is generally the most effective because it openly collaborative allowing participants to build on each others ideas.

Creativity exercises, relaxation exercises or other   activities before the brainstorming session can help participants relax their minds, so that they can be more creative during the session.

Various steps have been described:

The steps described here are:

1.   Define the problem or issue: The problem must be written concisely and clearly.  If the issue is broad, it is worth breaking down into smaller issues which can be brainstormed independently.

2.    Give a time limit:  Larger groups may need more time to get every ones ideas

3.   During the brainstorming session, participants give their ideas on solution to the problem while the facilitator writes it down.

4.   Ideas are selected which is liked best.  Ensure everyone involved in the brainstorming session agrees with the ideas.

5.   Write down criteria for judging which ideas best solve the problem.

6.   Give scores to each idea on a 0 - 5 point scale and select the idea with the highest score.

There are several key factors for a successful brainstorming session.

* State your challenge correctly:The brainstorming sessions participants need to    be given the right challenge to solve the problem.

* Avoid criticizing an idea or a person contributing the idea: Criticism makes the person who contributes the idea feel bad and it also tells others that unusual ideas are not welcome.

*  Have mixed participants.  This will help in generating creative ideas.

* Have an enthusiastic facilitator who compliments ideas, gives high praise to the most outrageous ideas.

*  Good environment   with no disturbances:  Avoid an uncomfortable environment. Very small room, telephone calls or any other kind of interruption.  The facilitator need to insist that the participants are not to be disturbed.

Conclusion: In nursing education, brainstorming is of great value as it enhances the critical thinking ability of nurses and help them become problem-solvers; as it is the need of the day in this ever challenging health scenario.

The goal of nursing education is to prepare nurses who are competent and caring.  Developing competent practitioners is the concern and responsibility of all nurses ( Andrew & Jones 1986 ).  To develop competent nurses, they require to be prepared in a way that they can use problem-solving and clinical reasoning skills in their practice.  Problem-based learning (PBL) is effective in enhancing the problem-solving abilities and clinical reasoning skills of students.

Problem-based learning is an increasingly popular educational strategy.  It has now been applied to many areas like nursing, space, science, community health.

etc.PBL can be best defined as the individualized learning that results from the processes involved in working toward the solution or resolution of a problem   (Barrows, HS and Tamblyn ).

1.  What is problem-based learning ?

Barrows ( 1985) describes " The basic outline of PBL process is :  encountering the problem first, problem-solving with clinical skills and identifying learning needs in an interactive process, self-study, applying newly gained knowledge to the problem and summarising what has been learned".

2.         What are the advantages of problem-based learning ?

a.Development of an effective and efficient clinical reasoning process

b.       Increased retention of data

c          Development of effective self-directed learning skills

d.Increased student-faculty interaction.

e.Increased Motivation for learning

d.         How is the tutorial process conducted for problem-based learning?

The problem-based strategy using the tutorial process is conducted in two sessions i.e. brainstorming and regrouping.  Students meet in small groups of six to eight, with a "tutor" who is the facilitator.  One student takes the role of the group leader who coordinates the sessions activities.  Another student takes the role of the scribe, whose task is to keep track  of the group's process on the board.

Patient problems are presented in a variety of formats like carefully designed printed format, computer format, video clippings etc.

The tutorial group begins with the brainstorming session.  The second session is the regrouping session.

Let us see the steps of the tutorial process as presented in Fig.

i.              Clarify unfamiliar terms and concepts

ii.            Define the problems/issues

iii.           Discuss / analyse the issues identified

iv.           Summarize the discussions

v.            Decide what new information is required to deal with the problem

vi.           Pursue learning objectives individually or together ( self-directed learning )

II.         Second Session :  Regrouping

vii.          Resource critique, re-analysis of the problem in the light of new information acquired, debriefing and evaluation.

When a new group of randomly assigned students meet for the first time, an introduction is done.  The students are asked to introduce themselves to the others in the group.  The others in the group are invited to ask questions to each student or comment on anything he or she might have said.  This helps students to establish who they are and their own importance as an individual in the group.  This will help to enhance the group process as problems of members identifying their own importance  in the group through this, inappropriate  behavior is avoided.

Conclusion:

PBL is a very useful method of teaching learning. Research evidence shows this.

INTRODUCTION:

"The more active they are [students] in determining and absorbing their own learning, the more they learn." (Mann 1996)

Teaching method was relentlessly passive; listen and read.

What about today?

• Today it is fashionable to "do". Good teachers "do", and they promote active learning.
• They seek to engage the student in the learning process.
• They stimulate the students' understanding of what is being taught.
• Get them to investigate, research and question outside the classroom.
• The learning process not comfortable, safe and passive.
• It is dynamic, challenging and active.
• Students encouraged engaging with their studies to become independent learners.
• Learning is an interactive process - both funs as well as academically rewarding.

• Enabling functioning if accompanied by a high amount of cognitive process.
• Facilitating function for specific cognitive process made easier through action.
• Students' knowledge on the character is increased in situation, issue or crisis.
• Oral, written or visual language in enhanced in the process.
• Can be performed as a classroom activity.
• Improves language skills.
• Movement is fundamental to covey meaning through drama.

• To increase knowledge of a character, situation or issue.
• Knowledge of oral, written and visual language is enhanced in the process.
• When performed in public, to be managed sensitively with good preparation, time for reflection and care that students take appropriate roles.

One dimension of this active learning approach to teaching and learning is dramatization namely games, role-play, simulation and mime.

Games, simulations, mime and role-play: What's the difference?

• The use of all these is well established in various fields other than nursing. There is a well-developed body of literature to support their use in the teaching environment.
• Collectively these provide students with some form of imaginary or real world within which to act out a given situation
• Each is quite distinct.
• Involves sound organization and planning.

Games:

• Any game which can be a means for learning.
• Have a set of clear rules.
• Encompass an element of competition.
• Tend to have winners and losers.

Simulations:

• Event or situation made to resemble clinical practice.
• Involves application and integration of knowledge, skills & critical thinking.
• Created to represent real environments.
• Deepens conceptual understanding of the real world.
• Change over time, reacting and adapting to your actions.
• Free from the competitive element.
• Excellent teaching strategy for many skills.

Role - play:

• Most simplistic form.
• Individuals play themselves or another, placed in a given situation.
• Person behaves as a result of what is going on around them.
• There is an element of game and simulation.
• Could have winners and losers.
• Environment clearly defined to simulate real world situation.
• An attempt by an individual to place themselves in the position of another or as themselves and deal with unfamiliar circumstances.

Key distinction between the three:

• There is degree of control over what the role-player does.
  • -          Control over environment within which the role-play takes place.
  • -          Process of socialization & learning roles go together.
  • -          Roles given by our social position or are ascribed upon us by what we do.
  • -          Any one-time role-player can perform any given number of roles.
  • -          Roles change depending upon the context.
  • -          Defines role of all involved.
  • -          Roles may not be familiar & may vary widely.
  • -          Expectations of a role and behavior that flows from it are identified even if unfamiliar.
• In games & simulations, roles - prescriptive, actions are programmed & structured.
  • -          Proceed in a particular order
  • -          Follow a particular direction.

Mime:

• The art of teaching through nonverbal communication, through exaggerated expressions, actions and gestures.
• The art of portraying characters and acting out situations or a narrative by gestures and body movement.
• Changes in thinking about drama in education.
• Creating characterization - instruct students to listen, watch arms, body movements.
• Performers physically express their adopted characters by their facial expressions and in every body movement.
• Every movement has a motivation and purpose.
• Communicates mood, response & new information to the audience.
• Medium for performing roles using words and focusing on conveying richness of meaning through visual language alone.

• The tutor relinquishes a high degree of control over the learning environment.
• If ineffective students will not learn.
• Threat of simplification can result in failure to make optimum use of knowledge.
• Students can simply play role in a shallow and ineffective manner.
• A good and successful role-play depends upon the quality of the students involved & the seriousness with which they embrace the exercise.
• Students may see this as a frivolous and entertaining exercise.
• These can be time consuming both in preparation, playing and debriefing.
• If included in formal assessment process this presents and additional problem of assessing student contribution and performance.
• The more open or free these are the bigger the issue these become

OVERCOMING DRAWBACKS:

• Devise clear guidelines.
• Use scripted dramatization
• Define roles and set the scenario
• Make it formal and more orderly
• Ideas should reflect their knowledge and understanding.
• Allow time to explore dimensions of the role they are in
• Ensure debriefing students which is crucial for success
• In assessment avoid open or free dramatization but assess through requesting a reflective essay in which student is asked to evaluate their role and learning experience.
• Identify what they feel, what they learnt from the experience and understand the consequences.

"Technology alone will not provide an adequate framework for innovation. It might be described as a missile looking for a target." (Freeman & Capper, 1998)

With the development of conferencing systems and virtual learning environments such as Web CT, the opportunity to use technology to aid teaching and learning is growing. Dramatization will also set to benefit. The use of conferencing systems, e-mail and the World Wide Web in this scenario is only just being evaluated. Such technology offers a number of unique and enriching additions to both the organization and operation of the dramatization in teaching and learning strategy.

"The web houses the virtual space for the role play, enables communication and collaboration among students, and between the students and the lecturers. The web also enables access to "just in time" resources by making available to students resources such as up to date news from electronic newspapers and web sites etc., from all over the world as and when they need them. Without this capability the content of the role play would be significantly weaker."(Linser and Naidu, 2001)

Technology is likely to improve the learning outcomes. With online technology it is possible to discuss issues via e- mail groups and by being on line answers to problems and issues can be considered with greater reflection. Students will enhance their understanding of technology and gain key transferable technology skills.

The drawbacks or weaknesses that one might anticipate from the enhanced use of technology in role-play scenario's, are I feel largely skill based. The transfer from verbal to written communication is a significant change. Effective face-to-face communication draws upon quite a distinct set of communication skills. E-mail and web based communication might also fail to create a learning community. The physical difference in cyber-space and the anonymity this creates might diminish rather than enhance an understanding of other groups and their views. As such maybe web-based role-play might be most effectively engaged in when used in conjunction with rather than a replacement of the more traditional face-to-face approach of this teaching method.

Conclusions

"Although the technique is relatively simple and one that most teachers and trainers can use without much prior experience, the difference between the best and worst run role-plays can be considerable. At best the exercise will be seen as relevant, essential part of learning; it will be an enjoyable and exiting experience and the students will be left with a greater understanding of their subject and a clear idea of how to develop it further. At worst the students will be board, embarrassed and even angry. They may have achieved very little and even acquired erroneous learning; they may be left with a feeling of inadequacy and not knowing what it was about." Van Ments (1989)

The educational benefits to be gained from using role-play are immense. With careful planning in both the construction, organization and running of the role-play, and with the added bonus of new technology, there is no reason why many of the weaknesses in this approach might not be overcome. In business and economics we are blessed with a series of disciplines that are rich in role-play material. With some investment of time on our parts it is possible to extend our repertoire of teaching talents, and hopefully, more effectively engage the student in a process of active learning.

1. Alden D Experience with Scripted Role-Play in Environmental Economics (Spring 1999) Journal of Economic Education
2. Francis P J & Byrne A P Use of Role-Play Exercises in Teaching Undergraduate Astronomy and Physics (1999) Astronomical Society Australia
3. Freeman M A & Capper J M An Anonymous Asynchronous Web-based Role-Play. (1998) http://www.bus.uts.edu.au/fin&econ/staff/markf/roleplay.html
4. Ip A, Linser R & Naidu S Simulated Worlds: Rapid Generation of Web-based Role-Play (2001) http://ausweb.scu.edu.au/aw01/papers/refereed/ip/paper.html
5. Brammer, M., & Sawyer-Laucanno, C. S. (1990). Business and industry: specific purposes of language training. In D. Crookall & R. L. Oxford (Eds.), Simulation, gaming, and language learning (pp. 143-150). New York: Newbury House.
6. Burns, A. C., & Gentry, J. W. (1998). Motivating students to engage in experiential learning: a tension-to-learn theory. Simulation and Gaming, 29, 133-151.
7. Christopher, E. M. & Smith, L. E. (1990). Shaping the content of simulation/games. In D. Crookall & R. L. Oxford (Eds.), Simulation, gaming, and language learning (pp. 47-54). New York: Newbury House.

The end of any Professional education is the attainment of sufficient knowledge with appropriate action. A health professional is wise but unable to act means he/she is a   defective product. This awareness has resulted in the shifting of

a-Passive teaching to active learning.

b-Transmission of biomedical knowledge to development of professional skills  & attitude

c-Verbal media- to Audiovisual media.

One of the vital components of the  interaction between the   Teacher & the taught  is effective communication  which is at present  achieved through   the development of  audio-visual computer technologies to the extent of making  self learning modules for the students.

The medical education technology is so advanced  through virtual reality -ie- computer based -3D interactive program.    Computers,  the 5th major revolution in education have become obiquitous today - seen in every walks of life ,especially the computers with multimedia capacity -added with sound ,animation  & 3D video. Eg- the effect on  the  student of 3D image of the internal ear, or animation of heart valve functioning

Traditional animation is   to create images which show an object in a movement & to direct us to think as if it moves by the help of playing these sequence of  hand - painted images one after another at a high speed ( 14-30 /sec)

2D - Computer animation

Digital drawings are made on a computer screen in adobe photoshop or hand - drawn/ printed diagrams are scanned in computer .All the simulated tools are available in the tool option - pencil,rubber,paint,brush etc.

3D- Computer Animation

In projecting  a 2D picture one after another  which are rendered  by means of width ,length, depth, in the space supplied by  computer software. The user's commands - the computer calculates  the details like movement, color, light,& perspective  of objects on the created visual stage  accurately & gives the outcome as as in image ,using sound music ,effects, that support the image can take the animation to it's goal so easily

General Advantages

1-      In the movie field

2-      TV educational programs

3-      Medical  education

a-      for health  care professional

b-      for Medical  & allied health science students

c-      for health care education of patients regarding  various procedures

d-     Mass media health education program

e-      Medical website design & development

Medical Animations  in Macromedia  Flash format

1-      Flash media is available in most of the computer systems

2-      The file size is very small- it opens quickly.

3-      It can be made interactive

Medical Animations are available

To  demonstrate

a-       Human  anatomy

b-       Physiology

c-      Genesis of  pathological lesions

d-     Signs & symptoms of illness

e-      Various Surgical techniques & procedures

f-       Principles of various investigations & interpretations of results

Advantages

a-      Animation has an  important role in  Medical education along with its  unique  value of grasping

b-       It makes  the  unseen  visible, making the abstract thoughts concrete, very close to the real appearance eg:- the blood cells flowing  in the circulation ,the fluid dynamics inside a working heart.

c-      Most animations are simple smooth & easily understood -have direct influence on the learning & understanding skills, since  it has the motion features ,the events that can not be filmed with camera in real life is shown step by step -Eg- the blood clotting mechanism .

d-     It helps to attract the audience by giving a richer expression in an ordinary way

e-      We can replace a real narrator using the animated image.

f-       The whole thing can be reproduced at any time  any place using the CD .

g-      For the students ,the digital class,the animations  in terms of visuality , attractiveness, arousing attention,easiness in perception  makes  the  learning so effective .

Problems & Limitations

a-It is inadequate for a candidate  to develop psychomotor skill through virtual reality

b-All topics cannot be taught with this .

c-Producing an animation is quite tedious, time consuming .

d-Faculty  involvement in the class room is little .

Conclusion

However  the Medical animations are having its wide applications  among Health care Professionals, all students of  Medical/Dental/Nursing/Pharmacy & Allied  paramedical courses,  all Hospitals ,Private practitioners  , Medical representatives

etc.

THE LECTURE

As the lecture is one of the common methods of teaching, here are a few DO'S and DON'T'S for a lecturer.

1.      DO plan your lesson in advance. This constitutes the skill of lesson planning.

2.      DO prepare good audio-visual material and use them properly.

3.      DO always keep the audience in mind. The material should be appropriate to the needs and background of the students.

4.      DO recognize the limitations of time. Highlighting significant points is more important than "Covering the portion".

5.      DO plan illustrative anecdotes or case reports. A carefully chosen "for instance" is very helpful in clarifying a difficult point.

6.      DO plan to ask questions or pose problems at intervals to create and sustain interest.

7.      DO try to keep the attention of the students throughout the lecture. This is done by Stimulus Variation (Refer Stimulus Variation).

8.      DO show enthusiasm and interest in the subject and students.

9.      DO summarise the main points towards the end of the lecture.

10.  DO evaluate your performance.

11.  DON'T lecture (give a monologue) for  more than 20 minutes   at a stretch.

12.  DON'T  be too sensitive to yawns, restlessness, whispered conversations etc. on the part of the students. They should not be taken as personal affront, but as pointers to change the strategy of presentation.

13.  DON'T  try to be complete.

14.  DON'T  mention anything only once.

15.  DON'T restate. CREATE !

16.  DON'T confess. PROFESS!

MISCONCEPTIONS ABOUT LECTURE

1.      Speech making = Instruction.

2.      Covering information = Teaching.

3.      Being heard = Communication.

4.      No questions = Understanding.

5.      Pleased group reaction = Learning.

6.      Teacher activity = Student involvement.

7.      In predominant use = Successful.

THE INGREDIENTS OF A GOOD LECTURE

PRESENTATION AND ORGANISATION:

Explained relevance of the topic

Audibility and clarity

Enthusiasm

Speed of lecture ( fast/ slow/ optimum )

Emphasis on important points

Explanation with appropriate examples

Optimum use of audio-visual aids

Eye to eye contact

Ability to hold  attention

Systematic presentation

Recapitulation and closure

CONTENT

Correctness of facts

Amount of factual content (too much/too little/optimum)