Knowles Adult Learning Theory

Knowles Adult Learning Theory has six assumptions about adult learners. These assumptions are:

1. Adults need to know why they need to learn something.
2. As people mature, their self-concept moves from one of being dependent toward one of being self-directed.
3. As people mature, they accumulate a large amount of experience that can serve as a rich resource for learning.
4. Real-life problems or situations create a readiness to learn in the adult.
5. As a person matures his or her time perspective changes from one of postponed application of knowledge to immediacy of application.
6. Adults are primarily motivated by a desire to solve immediate and practical problems. As a person, matures, motivation to learn is stimulated by internal stimuli rather than external stimuli (McEwen and Wills, Theoretical Basis for Nursing, 2006, p. 399).

Bloom’s Revised Taxonomy

Bloom’s Revised Taxonomy defines three domains of educational activities or learning: cognitive (knowledge), affective (attitudes), and psychomotor (skills).

Cognitive

The cognitive domain involves the ability to obtain and demonstrate knowledge. Acquisition of knowledge, attitude, and skills proceeds from simple actions such as memorization to more complex intellectual actions such as synthesizing information from multiple sources.  Bloom’s revised taxonomy discusses six categories of knowledge that describe the progression of knowledge from simple to complex:

Remembering – Recalling facts or basic concepts

Understanding – Explaining ideas or concepts

Applying – Using information in new situations

Analyzing –  Drawing connections among ideas

Evaluating – Justifying a stand or decision

Creating – Producing new or original work

Affective

The affective domain involves internally valuing the unique multidimensional individual, respecting the individual’s right to self-determination, as well as valuing the core beliefs of the nursing profession.

Psychomotor

The psychomotor domain involves performing coordinated fine motor, manual, and gross motor skills that are guided by intellectual reasoning.

Critical thinking in today’s complex health care system is necessary for safe, effective, and efficient patient care. Learning to critically think is successful when knowledge is presented in a systematic fashion wherein concepts are presented in a progressive manner of simple to complex incorporating all three learning domains.

Tanner’s Clinical Judgment Model

Tanners Clinical Judgement Model identifies the processes of clinical judgment that reflect the way nurses think in practice. As students learn to think like a nurse, the processes develop from noticing to interpreting, to responding, and then reflecting.

Noticing: a perceptual grasp of the situation at hand. It is the process of perceiving important or salient aspects of the situation and is the expectation for students in the first two quarters of the Nursing Program.

Interpreting: the development of sufficient understanding of a situation to respond. It is the ability to take the data in a situation and then determine the etiology, patterns, additional factors to consider or additional information needed and resolution; the ability to draw a conclusion. This is the expectation of students in the third and fourth quarters of the Nursing Program.

Responding: the ability to decide on a course of action, including no action. It requires the student to consider the situation and determine patient goals, nursing response and intervention; to develop a plan of care. It includes identifying stressors experienced when responding to the situation. This is the expectation for students in the fifth quarter of the Nursing Program.

Reflecting: the attention to the patient /family response to the nurse’s action while acting. It is the ability to identify what occurred, what the nurse did, and how one might adjust the action differently in the future. The nurse identifies what additional knowledge or skills needed. It includes reflection on values and feelings with the situation. This is the expectation of the students in the sixth quarter of the Nursing Program.

Patricia Benner’s Stages of Learning and Skills Acquisition

Patricia Benner’s research describes how nurses develop skills and an understanding of patient care over time through both education and experience in caring for patients.  Benner describes how beginning nurses progress through five distinct levels; novice, advanced beginner, competent, proficient, and expert.  According to Benner (2001), nurses move from the novice level of no experience to the next stage of advanced beginner, which demonstrates acceptable performance after having considerable experience with caring for patients. At the advanced beginner level, experience in actual patient care enables the nurse to recognize meaningful elements in the individual patient care situation and use those elements to guide care. Students are expected to be at the advanced beginner stage at the time of program completion.

Student-centered nursing education is best achieved when educators meet adult students at their level while creating an environment of mutual respect and collaboration in the educational process. Learning is an interactive process by which the educator and the learner share responsibility in obtaining successful student outcomes.  Through the Nursing Program’s use of the theories and research identified above, students transition from novice to advanced beginner and demonstrate clinical judgment necessary for safe entry-level practice in today’s complex healthcare environment.

References

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Prentice-Hall.
Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing Practice: Caring, clinical judgement, and ethics (2^nd Ed.), Springer Publishing.
McEwen, M. & Wills, E. (2006). Theoretical Basis for Nursing (2^nd Ed.). Lippincott Williams & Wilkins.
Moore, K (2012).  Effective instructional strategies: From theory to practice (3^rd ed.), Sage Publications.
Tanner, C. (2006). Thinking like a nurse: A researched-based model of clinical judgement in nursing. Journal of Nursing Education, 45, (6), 204-211.

Theory courses within the Nursing Program may be scheduled Monday through Friday and typically between 8:00 am and 6:00 pm. Clinical hours are generally scheduled between 6:00 am and 11:30 pm. Clinical experiences may rotate from day to evening shift. Some nights and weekends may be scheduled in order to gain specific experiences. Students must provide their own transportation. Travel may be required to outlying clinical sites.

Essential behaviors refer to those physical, cognitive, and behavioral abilities and competencies required for safe, satisfactory completion of all aspects of the nursing program. These behaviors are non-domain specific, i.e., those physical and mental activities and attributes needed by a nurse to practice safely in terms of essential nursing functions. Students in the nursing program must demonstrate competence in the following categories of behavior in order to successfully meet the program learning objectives. Inability to demonstrate competency with or without accommodations, may prevent a student from successfully completing the requirements of the program.

Clinical facilities utilized in the training of nursing students may have additional requirements that if not met, may result in the student’s inability to complete a clinical course and the nursing program.

The YVC Nursing Program signifies that the holder of the ADN degree has been educated to competently practice nursing in all healthcare settings and to apply for RN licensure in the State of Washington. The education of a nurse requires assimilation of knowledge, acquisition of skills, and development of judgment through patient care experiences in preparation for independent, semi-autonomous practice where making appropriate decisions is required. The practice of nursing emphasizes collaboration among physicians, nurses, allied health care professionals and the patient.

The curriculum leading to the ADN requires students to engage in diverse, complex, and specific experiences to the acquisition and practice of essential nursing skills and functions. Unique combinations of cognitive, affective, psychomotor, physical, and social abilities are required to satisfactorily perform these functions. These functions are necessary to ensure the health and safety of patients, peers, faculty and other healthcare providers.

The essential behaviors following this paragraph are necessary to acquire or demonstrate competence in a discipline as complex as nursing. These behaviors are in addition to the standards of behavior and academic conduct set forth in the YVC Code of Students Rights and Responsibilities (published on the College’s website).

Motor Skills

Students should have sufficient motor function so that they are able to execute movements required to provide general care and treatment to patients in all health care settings. [For example: For the safety and protection of the patients, the student must be able to perform basic life support, including CPR, and function in an emergency situation. The student must have the ability, within reasonable limits, to safely assist a patient in moving, for example, from a chair to a bed, or from a wheelchair to a commode. Additionally, students must demonstrate competent computer skills including word processing.

Sensory/Observation

A student must be able to acquire the information presented through demonstrations and experiences in the basic and nursing sciences. He or she must be able to observe a patient accurately, at a distance and close at hand, and observe and appreciate non-verbal communications when performing nursing assessment and intervention or administering  medications. The student must be capable of perceiving the signs of disease and infection as manifested through physical examination. Such information is derived from images of the body surfaces, palpable changes in various organs and tissues, and auditory information (patient voice, heart tones, bowel and lung sounds).

Communication

The student must communicate effectively and sensitively with other students, faculty, staff, patients, family, and other professionals. He or she must express his or her ideas and feelings clearly and demonstrate a willingness and ability to give and receive feedback. A student must be able to: convey or exchange information at a level allowing development of a health history; identify problems presented; explain alternative solutions; and give directions during treatment and post- treatment. The student must be able to communicate effectively in oral and written forms. The  student must be able to process and communicate information on the patient’s status with accuracy in a timely manner to members of the health care team. The appropriate communication may also rely on the student’s ability to make a correct judgment in seeking supervision and consultation in a timely manner.

Cognitive

A student must be able to measure, calculate, reason, analyze, integrate and synthesize in the context of undergraduate nursing study. The student must be able to quickly read and comprehend extensive written material. He or she must also be able to evaluate and apply information and engage in critical thinking in the classroom and clinical setting.

Behavioral/Emotional

A student must possess the emotional health required for the full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients and families. In addition, s/he must be able to maintain mature, sensitive, and effective relationships with patients, students, faculty, staff and other professionals under all circumstances including highly stressful situations. The student must have the emotional stability to function effectively under stress and to adapt to an environment that may change rapidly without warning and/or in
unpredictable ways. The student must be able to experience empathy for the situations and circumstances of others and effectively communicate
that empathy. The student must know that his or her values, attitudes, beliefs, emotions, and experiences affect his or her perceptions and relationships with others. The student must be able and willing to examine and change his or her behavior when it interferes with productive individual or team relationships. The student must possess skills and experience necessary for effective and harmonious relationships in diverse academic and working environments.

Professional Conduct

Students must possess the ability to reason morally and practice nursing in an ethical manner. Students must be willing to learn and abide by professional standards of practice. Students must not engage in unprofessional conduct, and must possess attributes that include compassion, empathy, altruism, integrity, honesty, responsibility and tolerance. Students must be able to engage in patient care delivery in all settings and be able to deliver care to all patient populations including but not limited to children, adolescents, adults, developmentally disabled persons, medically compromised patients, and vulnerable adults.

Yakima Valley College is committed to supporting student success and provides opportunities for students to demonstrate these essential behaviors. If an applicant to the program or a student enrolled in the program believes he or she has a disability that could affect their demonstration of competence in one of the above categories, the student must see the ADA Coordinator, located in the Deccio Building, phone number 509.574.4961. To successfully complete the nursing program, the student must be able to demonstrate competence in their performance of all essential behaviors either with or without accommodation.

Washington State Nursing Care Quality Assurance Commission Licensure Regulations

Schools of nursing are approved by the Washington State Nursing Care Quality Assurance Commission (NCQAC) which monitors the quality of education in these institutions. The NCQAC also licenses practical and registered nurses and, therefore, has a legal right to inquire about aspects of your personal life which might impair your ability to practice safely as a licensed nurse. When you near completion of the Nursing Education Program, you will make application to the NCQAC for your licensing examination. A portion of this application asks you to answer “yes” or “no” to the following questions:

1.  Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?
2. Do you currently use chemical substance in any way which impairs or limits your ability to practice your profession with reasonable skill and safety?
3. Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism, voyeurism, or frotteurism (recurrent pre-occupation with touching a non-consenting person)?
4. Are you currently engaged in the illegal use of controlled substance?
5.  Have you ever been convicted, entered a plea of guilty, nolo contendere, or a plea of similar effect, or had prosecution or sentence deferred or suspended in connection with:
   • the use or distribution of controlled substances or legend drugs?
   • a charge of a sex offense?
   • any other crime, other than minor traffic infractions? (Include driving under the influence and reckless driving.)
6.  Have you ever been found in any civil administration or criminal proceeding to have:
   • possessed, used, prescribed for use, or distributed controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes, diverted controlled substances or legend drugs, violated any drug law, or prescribed controlled substances for yourself?
7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a health care profession? If “yes” explain and provide copies of all judgments, decisions, and agreements.
8. Have you ever had any license, certificates, registration or other privilege to practice a health care profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority, or have you ever surrendered such credential to avoid, or in connection with, action by such authority?
9. Have you ever been named in any civil suit or suffered any civil judgment of incompetence, negligence or malpractice in connection with practice of a health care profession?

If you answer “yes” to any of these questions, full details must be furnished to the NCQAC. Be sure to tell the truth and contact the Commission early to determine their requirements.

The laws of Washington do not allow community college programs to discriminate in their admission process based on difficulties in any of the areas covered by these questions. Consequently, it is possible that you could be admitted to, and successfully complete, our program and still not be eligible for licensure.

The NCQAC will not discuss the possible action it might take regarding your eligibility for licensure until you apply for the exam. Therefore, if you have any concerns regarding these questions, it is recommended that you discuss them with the Program Coordinator prior to entering the Nursing Program.