Instructional Design Theory in Nursing Education – Part 1

Using theory to guide any course design is central to my team’s practice and my design practices. Theory is important due to my environment and what I find to be best practices. Without using theory to guide my design decisions and suggestions, I would be designing blindly, which leads to heavy courses with minimal organization and scaffolding. This creates a difficult learning experience for students, at minimum.

Instructional Design Theory in Nursing

In my transition to Nursing in Higher Education, I am learning how theories I often reference can be translated and tailored to nursing courses. I’m positive I’ll keep learning and testing new ideas and strategies as our education and healthcare systems evolve.

Bloom’s Taxonomy Domains within Nursing Design

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Bloom’s Taxonomy is a commonly used theory in Nursing Education and it’s used in much of the design work I do for course design. It’s most helpful in aligning course outcomes or objectives with course materials, learning activities, and assessments of learning. In addition, the affective domain is easily missed when designing a course, yet it is central to the quality, safety, and ethics of nursing practice. For instance, the affective domain of knowledge guides nursing decisions based on values and beliefs. And if there aren’t any values or beliefs being taught in nursing, then how can we measure their effectiveness to make well-rounded decisions about patient care?

In a nursing degree or course, fostering self-reflection and evaluating the level students’ value a process or philosophy. In one study, nursing educators described affective domain activities that “touches my heart as well as my brain,” and get at “how I feel, how you feel.” This could be seen as another way to teach empathy and compassion in a course or as part of a degree program.

Contextual Learning

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Forneris and Peden-McAlpine suggest using elements of critical thinking and a narrative process to provide a contextual learning experience for nursing students. The authors state, “Stories as narrative provide the mechanism for understanding as they can be reflected on, reanalyzed and understood.”

In the classroom or online course environment, this could be operationalized as a facilitated activity or series of activities guiding nursing students through reflecting on a personal nursing experience, determining the context of their experience, having dialogue with the instructor and other classmates, and putting the story into the timeline of past, present, and future. I could see this activity being a journal, reflective video, or a Pecha Kucha presentation.

Gagne’s Theory of Instructional Design

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Gagne’s Theory of Instructional Design follows a specific process of designing outcomes, followed by instructional events the learners must complete to achieve the outcomes. There are five learning outcomes and nine events used to design a learning experience using Gagne’s theory.

For one research study, nursing students learned how to do a pertuaneous chest tube insertion. The designers started with a pre-test to gain the students attention and emphasis the importance of this practical skill. Then the designers gave the students the objectives, which provided a roadmap for the learning process to the students. The rest of the process went as follows:

  1. Stimulate Recall – students recalled prerequisite knowledge of the chest area and organs to organize their knowledge into schemas and build upon this knowledge in the new learning experience, inserting a chest tube.
  2. Present Stimulus Material – instructors presented a series of pictures for the procedure to the students to teach the steps and logistics of the procedure.
  3. Provide Learning Guidance – instructors demonstrated the full procedure by playing a video twice, once all the way through without interruption, and once with pauses for questions and explanations.
  4. Eliciting the Performance – students perform the procedure while cohort and instructors observe.
  5. Giving Feedback – students received feedback from the instructors and were given opportunity to reflect on their performance.

Implications for Design and Teaching

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After re-reading what I have above, I noticed there is one thing all of these theories have in common: reflection. Without reflection, the nursing student may not effectively make connections between context, knowledge, and procedures.

By using Instructional Design theory to guide design, there is opportunity to incorporate reflection principles, provide structure and organization, and align class activities with outcomes.