Implementing Inquiry-Based Learning in Nursing

Dankay Cleverly

• Éditeur: Routledge
• Année: 2003
• ISBN:
  9781134478200
• Édition: 1
• Sujet: Medicine
• Sous-sujet: Health Care Delivery

If you want to introduce Inquiry-Based Learning (IBL) into your curriculum but are not sure how to go about it, this book will set you on the right track. Inthis text the author shares the experience of leading a project to implement IBL as a whole integrated pre-registration curriculum and provides a blueprint for successful implementation.The practicalities of implementing IBL can be a daunting prospect. Using a wealth of examples, relevant theories, models and research, this book takes the reader through the logistics of every stage of implementation. It provides the necessary theoretical and research perspectives and describes the detail how to manage the project stage by stage, covering planning, implementation, evaluation and change management. In addition, it looks at the operational practicalities and describes eight subprojects: staff development; communication systems; the classroom compass; practice experience; documentation; electronic' library and media resources, as well as reviewing the post implementation situation.Whether you are new to or already familiar with Inquiry-Based Learning or simply need some practical guidelines, this book will provide an indispensable source of reference.

Part I

Why inquiry-based learning?

Chapter 1

Introduction: background

In the past, the belief that psychomotor expertise was all that nurses should aspire to pervaded traditional nurse education and shaped its delivery strategy. The hidden curricular outcome was the socialization of each new intake of students into the order-and-obedience culture of the traditionally trained nurse. Paradoxically, by ignoring higher educational goals and confining its provision to elementary vocational domains, traditional training seems to have engineered its own failure. Student nurses, it appeared, ‘were not getting the preparation they needed to take on the job of staff nurses’ (Shand 1987: 28). The indoctrination into an authoritarian nursing hierarchy that was embedded in the educational process left the hapless newly qualified staff nurse shorn of almost any analytical capacity and virtually incapable of criticizing, let alone mounting any serious challenge to, the status quo – as Lathlean (1987) observed. These professional inadequacies originated in, or were at least exacerbated by, the traditionally minded schools of nursing as far back as 1986, where Sweeney (1986) saw how teacher-centred approaches stifled critical reasoning and fostered negative attitudes to research, change, and student autonomy.

The United Kingdom Central Council (UKCC) (1986: 33) proposed a realignment of nursing education that would enable it to deliver ‘a mature and confident practitioner, willing to accept responsibility, able to think analytically and flexibly, able to recognize a need for further preparation and willing to engage in self development’. Out would go the educationally bankrupt teacher-centred practices that were philosophically opposed to this aim. In would come the student-oriented methods that would signal the end of training by apprenticeship and the advent of the undergraduate student of nursing.

In the mid-1990s, the English National Board for Nursing, Midwifery and Health Visiting (ENB) (1994: 2) called for a more general adoption of those learning approaches that ‘enabled [students] to acquire the skill of “learning to learn” and the motivation to continue to do so’. Students should be self-directed individuals, responsible for their own learning during the programme and capable of continuing their education after registration. The realization of this ambition presented a problem to curriculum designers, educators and students, since it entailed a radical departure from traditional teaching/learning practice, with a transfer of knowledge from educator to student. Henceforward what would be taught is the art or skill of learning itself. Students would learn how to learn and gain knowledge directly for themselves without relying on the mediation of educators.

Many nurse educators failed to make the large change in their attitudes and methods that treating students as self-directed adults demands. They persisted with a well-worn teacher-centred approach in spite of its obvious incompatibility with the concepts of personal autonomy, accountability and responsibility that a Department of Health (DoH) (1989) report identified as essential components of contemporary professional nursing practice. Their unwillingness to change, for whatever reason, puts them out of step with the strategic direction chosen by nursing and by nurse education.

Tradition-oriented nurse education institutions have been reproached in a World Health Organization (1993: 3) report because ‘Imparting discrete facts and organizing knowledge by discipline simplify the tasks of teachers, but do not necessarily help learners to acquire easily and efficiently the skills they need to address the health problems they are likely to encounter in practice’. Problem-based learning was advanced as an important educational strategy to improve professional education. But despite repeated appeals from regulatory bodies and progressive educationalists like Knowles (1990) to discard the inefficient and ineffective teaching and learning practices of the past, the pedagogical model endures, throwing a long shadow over contemporary nurse education.

Project 2000 was an educational model intended to prepare nursing students to be more able to deal with changing health care demands and provide quality care upon registration. Since it was implemented in 1989, abundant feedback concerning the programme’s strengths and weaknesses suggests that practical constraints often meant that the sought after transformation of nurse education has been less radical in operation than planned – especially with regard to its defining attribute, student–centredness. Jowett (1995) and Willis (1996) observed that substantial numbers of nursing students in the common foundation programme were being taught in single large groups. Many students, understandably, find the prospect of asking a question in the presence of a sizeable audience too daunting – and are thereby denied the opportunity to participate in their own learning. Similarly on the other side of the equation, teachers ‘have to predominantly lecture to large groups rather than being able to use smaller group methods’ (Luker et al. 1995). These observations demonstrate that structure tends to determine function. An obvious example is the way in which the physical structure of a lecture hall is designed to enable everyone in the audience to see and hear the lecturer – not each other. Attempts to insert student-centred functions forcibly into structures which are purpose-built to optimize the traditional educational paradigm of teacher-directed lectures and textbooks are fraught with difficulty.

In Making a Difference (Department of Health 1999) and Fitness for Practice (United Kingdom Central Council 1999), summarized in Education in Focus (English National Board for Nursing, Midwifery and Health Visiting 2000), the nursing profession’s governing bodies addressed the issue of structure, making radical change in the pre-registration curriculum a key recommendation – along with the development of lifelong learning skills. New structures would support student-centred programmes using new strategies of learning. As Long et al. (1999), Gibbon (1998) and Biley and Smith (1998) reported, progressive elements in nurse education were already anticipating these recommendations. A review of the literature shows nurse educators in the United Kingdom implementing one or other of three closely related new learning processes. Though differing somewhat in structure, process steps, terminology and philosophical emphases, these learning strategies draw ideas from the same conceptual well. They are problem-based learning (PBL), enquiry-based learning (EBL) and inquiry-based learning (IBL).

The choice of IBL: a different approach to learning nursing

Anglia Polytechnic University (APU) made the decision to introduce an inquiry-based approach to learning in the pre-registration nursing curriculum in 1998. APU had been moving towards the introduction of a student-centred learning methodology for some time in response to encouragement from statutory and professional bodies – as discussed previously. Progress in this direction quickened when, for instance, nurse practitioners, academics and students began to report that pre-registration nursing students seemed to be experiencing difficulty in transferring knowledge acquired in the theoretical components of the curriculum into the practice area.

The IBL approach introduced in the pre-registration nursing curriculum at APU derives ultimately from the PBL model developed in Canada at McMaster University (Feletti 1993). This had been designed for use in the medical school as a way of overcoming learner passivity and linking theory and practice. Following its conspicuous success at eradicating medical student inertia, PBL radiated from its point of origin to other institutions and professions, including nurse education (Barrows 1996, Rideout and Carpio 2001). IBL was seen to be the best tool that APU could employ to urge students towards active learning and to mount a robust attack on the theory–practice gap.

Although nurse educators enthused over the process of problem-based learning, some found themselves at odds with the label ‘problem’ (Walton and Matthews 1989). Lest this reservation is thought to be hypercritical, it should be noted that the term is more than just a name. It is integral to the definition of PBL, which considers that every learning experience begins with a problem. There are two reasons why such a premise can only be regarded as unsatisfactory in contemporary nursing. First, it militates against the holistic view of health by implying only problems are of interest, that is, it concentrates attention exclusively on a client’s illness rather than examining a client’s needs. Second, it implies that discovering a workable solution is equivalent to, or at least as good as, gaining a full understanding – with the consequent danger that new client care strategies might simply be rehashed from existing practices rather than being developed from new research. A more generally acceptable proposition is that every learning experience begins not with a problem but a question. In recognition of this philosophical difference, the alternative designations of enquiry-based learning and inquiry-based learning are tending to find favour in more recent introductions of the methodology – a small but crucial change in emphasis that alters the whole tone of the learning approach when it is implemented.

A further disharmony between PBL and nurse education, which stems one supposes from its origins in medical education, is that it has a diagnostic-like structure – which makes it a fairly formal methodology, unlike IBL which ‘starts with fewer assumptions and has broader goals for the students and roles for the teachers’ (Feletti 1993: 150). The less rigidly structured, more open IBL approach seems better suited to investigation in clinical circumstances too, where the domains of the individual, society, disease and wellbeing intermingle across fuzzy ill-defined boundaries. It was to exploit this attribute of flexibility that IBL was introduced into the University of Hawaii’s School of Nursing in 1992 (Magnussen et al. 2000).

By 1993 Feletti felt able to describe a model of IBL that would ‘revitalize nursing’. The attractiveness of this model was enhanced by its added functionality – a framework for curriculum planning and evaluation, a number of different learning/teaching approaches to bridge the theory–practice gap, and a template for lifelong learning. It is Feletti’s model that has been adapted for use at APU, an educational philosophy and a methodology that are already beginning to revolutionize the activities and aspirations of students, academics and practitioners.

Chapter 2

Inquiry-based learning domains

Defining the IBL model

IBL is an orientation towards learning that is flexible and open and draws upon the varied skills and resources of faculty and students. Faculty are co-learners who guide and facilitate the student-driven learning experience to achieve the goals of nursing practice. This includes an inter-disciplinary approach to learning and problem-solving, critical thinking and assumption of responsibility by students for their own learning.

(Feletti 1993: 146)

It is evident from the foregoing that some words used in talking about IBL have an import that goes beyond their use in everyday language. To reduce the possibility of confusion or error, a list of the key terms associated with IBL and its implementation are defined here.

Critical thinking The IBL methodology relies on activities like exploration, discussion, analysis and the synthesis of new and old learning, all of which exercise the cluster of investigative and deductive skills that characterize critical thinking. The very act of asking questions is a renunciation of ‘things as they are’, or, more precisely, a suspension of belief that the situation is really as it is perceived to be and beyond that, a distrust of the habits of mind that shaped that perception. Scepticism about the rightness of the accepted view and a readiness to challenge the status quo are hallmarks of the IBL student and integral to the process of critical thinking and clinical reasoning.

Facilitation The IBL facilitator works in an open partnership with students – encouraging, guiding and supporting their explorations with open-ended questions and by acting as a resource. The facilitator makes a contribution as a learner among learners and is as willing to explore unfamiliar domains of knowledge as any other student.

Flexibility The individuality of students is echoed by differences in the ways in which they prefer to learn. IBL handles individual preferences in learning styles by the deployment of a wide variety of learning methods. The flexibility of provision extends beyond self-directed learning and the IBL tutorial to include, for example, lectures formatted as resource sessions or with content chosen by the students.

Interdisciplinary approach IBL elevates learning with others over learning by oneself. Appropriately differentiated models for collaboration in interdisciplinary and intradisciplinary groups can be employed to promote teamwork (Feletti 1993). The deliberate emphasis on joint learning endeavours seen in IBL represents a radical departure from traditional modes of academic delivery. By combining their disciplines, students, facilitators and practitioners from across the board in the care community are able to fashion a formidable investigatory tool for use in the shared exploration of scenarios.

Openness Openness – intellectual, psychological and emotional – is intrinsic to the IBL approach, where it is a defining attribute of facilitation, a prerequisite for flexibility, and the medium in which the interdisciplinary approach operates. The students ‘are open to experience, to new ways of seeing, new ways of being, new ideas and concepts’ (Rogers 1980: 350). Openness is a two-way street. It is as much about opening up to others – revealing perhaps unexpected capabilities but also exposing personal limitations – as it is about being open to receive new inputs. Experiencing trust and being trusted promotes self-discipline and responsibility – the requisites of lifelong learning.

Problem-solving Problem-solving is a knowledge depen...

Table des matières

• Cover 
• Half Title
• Title
• Copyright
• Dedication
• Contents 
• List of Figures
• About the Author
• Preface
• Acknowledgements
• PART I: Why Inquiry-Based Learning?
• PART II: Inquiry-Based Learning Project Implementation
• PART III: Operational Practicalities: The Subprojects
• PART IV: By The Time Tomorrow Comes
• Appendix 1: Postgraduate Student's Reflection: Extracts
• Appendix 2: Virtual IBL Group: Extract From Workbook
• References
• Index