Journal of Nursing Education

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Teaching Methodologies: Knowledge Acquisition and Retention

Karen K Roberts, RN, MN; Hester I Thurston, RN, EdS

Abstract

ABSTRACT

In studying the curriculum of a nursing program, knowledge acquisition and retention by nursing students is a primary concern of nursing instructors. The purpose of this study was to determine if a lecture which stimulated several senses would significantly increase knowledge acquisition and retention compared to lectures that stimulate only the auditory sense. Forty-three, junior year, diploma nursing students who had essentially the same clinical experience were the subjects randomly assigned to either Group A or B for this study. Group A (control group) attended a formal lecture on "Spinal Cord Injuries" which stimulated only the auditory sense. Group B (experimental group) attended a lecture on the same subject which stimulated the auditory, visual, and tactile senses. A pretest was given to evaluate the knowledge base prior to the lecture, a posttest was given immediately after the lecture to evaluate initial knowledge acquisition, and a retention test was given three weeks later to evaluate amount of knowledge retained.

Students attending the multimodal lecture demonstrated a significantly higher retention test score at the .05 level although they did not demonstrate a significantly higher gain score from pretest to posttest.

Abstract

ABSTRACT

In studying the curriculum of a nursing program, knowledge acquisition and retention by nursing students is a primary concern of nursing instructors. The purpose of this study was to determine if a lecture which stimulated several senses would significantly increase knowledge acquisition and retention compared to lectures that stimulate only the auditory sense. Forty-three, junior year, diploma nursing students who had essentially the same clinical experience were the subjects randomly assigned to either Group A or B for this study. Group A (control group) attended a formal lecture on "Spinal Cord Injuries" which stimulated only the auditory sense. Group B (experimental group) attended a lecture on the same subject which stimulated the auditory, visual, and tactile senses. A pretest was given to evaluate the knowledge base prior to the lecture, a posttest was given immediately after the lecture to evaluate initial knowledge acquisition, and a retention test was given three weeks later to evaluate amount of knowledge retained.

Students attending the multimodal lecture demonstrated a significantly higher retention test score at the .05 level although they did not demonstrate a significantly higher gain score from pretest to posttest.

The evaluation of educational outcomes is a complex process especially as it relates to the teaching/learning activities provided for students in nursing. Today, nurse educators are concerned with evaluation of educational outcomes; this is particularly important as the emphasis in nursing has recently focused on the development of models to teach nursing content and to provide a framework for the practice of nursing. Because many models are used in both education and practice, educators are examining strategies which enhance the teaching/learning process. This study was designed to examine whether or not a multimodal approach to the lecture method would significantly improve knowledge acquisition and retention when compared to a monomodal approach.

While students are enrolled in nursing education, a vast amount of information is expected to be mastered. Knowledge acquisition and retention of nursing content are necessary for safe nursing practice and, of course, to successfully write the State Board Test Pool Examination. Thus, a primary concern of nurse educators is finding ways to increase the effectiveness of the learning process. In examining knowledge acquisition and retention, Bevis (1978, p. 78) wrote that studies indicate the recall of "facts" decreases at a high rate. For example, at the conclusion of a course whose primary objective is the learning of facts, the learner can remember about three fourths of the information; at the end of a year, he can remember about half of the material; and at the end of two years, he can remember about one fourth of the material. Huckabay, Cooper, and Neal (1977) stated that although some material is forgotten, memory and retention depend largely upon the degree of learning that originally takes place. Thus, teaching methodology is a factor that may strongly influence knowledge acquisition and retention.

Formal lecture presentation probably has been the most commonly used instructional method in education. Recently, various mechanized and independent teaching/ learning strategies have been available to educators and students as alternatives or adjuncts to the lecture. An example of one of these methodologies is the use of audiovisual aids. An important difference between formal lecture presentation and the lecture with accompanying audio-visual aids is the sensory stimulation each provides. Audio- visual aids stimulate several senses (multimodal) and may allow for learning based on individual differences and preferences. The formal lecture presentation predominantly stimulates only the auditory sense (monomodal).

Much of the research investigating the superiority of either multimodal or monomodal sensory input has been done in educational psychology. In contrast, the amount of similar research conducted in nursing education is extremely sparse. Recent studies focus more on comparing autotutorial techniques to formal lecture techniques. Autotutorial techniques are valuable learning methods, but these techniques are viewed as adjuncts to the lecture rather than its replacement. Lectures can offer the unique opportunity for students to interact and learn from highly qualified teachers and specialists; this offers a valuable experience and should not be removed from students despite the rather intense marketing of the many technological products. Currently, lectures are an important means of providing theory and content in curricula, and they should be seriously assessed for their quality and effectiveness. This leads to the question, "Does multiple sensory stimulation improve acquisition and retention of nursing content?" If it does, then instructors in nursing can incorporate multiple sensory stimulation as a strategy to add variety and enhancement to the teaching/learning process.

Review of the Literature

As early as 1940, Ryan (1940) concluded there was sufficient research available to emphasize that interaction occurred between sensory systems during learning. Later, Hsia (1968) stated that despite the increased number of experimental studies concerned with multimodal stimulation, there still lacked a generally accepted theory concerning the use of media. In 1976, Menne and Menne (1972) found that studies designed to determine the superiority of multimodal sensory stimulation, in learning over monomodal sensory stimulation were still scarce, and those few reported demonstrated inconsistent results.

The present controversy over sensory stimulation apparently centers on whether man's nervous system can process information received over more than one channel at a time. In the literature two predominantly opposing theories exist. In 1958, Broadbent (p. 297) concluded that one channel is superior over multiple channels, and his "single communication channel" concept describes his theory. He described his Y system theory as one in which auditory (A) and visual (V) stimuli are like balls rolling down from the bifurcated tops of the Y to the central nervous system. IfA and V stimuli arrive simultaneously, then information jamming will occur. Hsia (1968) on the other hand, supported multiple channel stimulation. He contended that the concept of a single information processing channel is demonstrably insufficient. In dual or multiple channel information processing, dimensionality of information generally increases, and one channel provides cues and clues for the other. Hsia believed this was the case, provided the information to be processed has not reached the individual's capacity limit. Information processed through bisensory modalities, (A) auditory and (V) visual, possess a certain amount of (R) redundancy. When A and V simultaneously present the same information, between -channel redundancy reaches unity, and, therefore, information jamming can hardly occur.

A number of studies measuring knowledge acquisition of college students have been reported. Rankowski and Galey (1979) tested the effect multimedia had on teaching descriptive geometry. He compared the conventional lecture presented orally with only the aid of a chalkboard to a multimedia approach which used television and 35-mm slides. Results showed higher mean scores and lower standard deviations for subjects in the multimedia group. Watts (1976) compared the effectiveness of lecture, independent study, and audio-visual presentation teaching methods. The subjects were students enrolled in a college human sexuality course. Results showed that those subjects learned significantly better in the lecture group when compared to the audio-visual group. In another investigation, Jensen and Knauff (1977) studied biology students. They found that the effectiveness of the multimedia approach was affected by the complexity of the material presented, and knowledge acquisition of complex materials was enhanced considerably when multimedia was used.

Fewer studies in nursing education have tested the relationship of audio- visual aids and knowledge acquisition. As early as 1944, Heidgerken (1944) espoused the value of media as a methodology for teaching nursing. Two groups of nursing researchers have tested the effectiveness of audio-visual aids. Huckabay, et al. (1977) compared the teaching methods of (1) filmstrips and discussion, (2)lecture, (3) lecture and discussion, and (4) filmstrip. No significant differences were reported between any of the groups with respect to the amount of cognitive learning that initially took place. Schorow, Osborne, and Kelsey (1971) compared a conventional lecture presentation with a multimedia presentation that utilized 16-mm films, filmstrips, and audiotapes. Data did not show that one group consistently learned better than the other group. It did show, however, that some material was acquired better by the conventional group while other material was acquired better by the multimedia group.

The effect that audio- visual aids have on learning retention has not been widely studied by either educational psychologists or nurse educators. Siegel (1973) used general psychology students to compare the effectiveness of television, radio, print, and lecture methods of teaching. Results demonstrated that initial knowledge acquisition was highest among students taught by print and was lowest among those taught by radio. A retention test given two months later elicited the same results. Interestingly, he found that content influenced the effectiveness of the media. Content which emphasized perception and created visual imagery was more effectively taught by video methods. Thompson (1972) compared the effectiveness of two teaching methods in nursing education. These were: (1) the conventional lecture; and (2) a multimedia, autotutorial approach that utilized slide-tape programs, videotapes, programmed instruction booklets, and 16-mm films. One year after the material was initially presented, the investigator reported finding no significant difference in the knowledge retention between groups. In conclusion, the literature reflects conflicting reports concerning whether or not single or multiple channel teaching methods result in more learning and better retention.

Purpose

The purpose of this study was to compare knowledge acquisition and retention of subject matter presented to nursing students when using two teaching modalities: lecture supplemented with audio-visual aids and traditional monomodal lecture.

Hypothesis

Two hypotheses were formulated for this study: (1) Subjects taught by a multimodal sensory (MLS) lecture approach will demonstrate a significantly higher score on a posttest than those taught by a monomodal (MNS) lecture approach; (2) Subjects taught by a multimodal sensory (MLS) lecture approach will demonstrate a significantly higher score on a retention test than those taught by a monomodal sensory (MSN) lecture approach.

Theoretical framework

There is a basic agreement among psychologists that learning refers to a change in performance arising from an experience (Mouly, 1968, p. 298). To further define learning and identify its intrinsic components, either a cognitive, behavioral, or computer model of theory of learning must be selected (Huckaby, et al., 1977). For the purpose of this study in which the effects of sensory stimulation on learning behaviors or responses are observed, the behavioral theory of stimulus-response learning was selected. Learning was defined as a relatively permanent change in behavioral tendency that has come about as a result of reinforced practice. Learning retention was defined as the capacity to utilize a response once acquired at a later time.

For Gagne (1970, p. 71) the learning process is a concept which consists of learning and retention that takes place over a period of time. His four phases of a learning event are (1) the apprehending phase, (2) the acquisition phase, (3) the storage phase, and (4) the retrieval phase. After a stimulus situation has been presented, a learner initially apprehends or registers what was presented. During the acquisition phase, the learner can execute a new task or behavior to demonstrate learning. The storage phase follows when the new behavior is retained and stored for later use. Retrieval occurs when the stored behavior can be recovered and demonstrated for an observer. The acquisition and retrieval phases were the events evaluated by this study.

Definition of Terms

Monomodal Sensory Lecture (MNS): Lecture presented verbally stimulating only the auditory sensory mode.

Multimodal Sensory Lecture (MLS): Lecture presented verbally with the addition of visual aids and three dimensional models that will stimulate auditory, visual, and tactile sensory modes.

Control Group A: Those subjects exposed to the monomodal sensory lecture.

Experimental Group B: Those subjects exposed to the multimodal sensory lecture.

Sample

The subjects were junior year diploma nursing students enrolled in an orthopedic/neurologic course. Students eligible to participate were those who had not previously taken a neurology course or cared for a spinal cord injured person. Forty-three eligible subjects participated. Subjects ranged in age from 19 years to 52 years with a mean age of 25. Forty-two subjects were female, and one was male. Group A (Control) was composed of 22 subjects, Group B (Experimental) had 21.

Instrument

A 50-question multiple-choice achievement examination was constructed to test both knowledge acquisition and retention. Questions were written utilizing Bloom's Taxonomy for classification so as to test all six cognitive levels. A table of specifications was used to correlate test items with instructional objectives.

Content validity of the achievement examination was established by a panel of five expert judges (faculty and clinical specialists). A pilot test was administered to a group of senior nursing students who had taken the course previously. Internal consistency was established through computer comparison of the upper criterion group with the lower criterion group on each question. Reliability of .72 was established by the Kuder Richardson formula 20.

Procedure

Group A (Control) was exposed to a monomodal presentation of the lecture "Nursing Care of the Spinal Cord Injured Person." This lecture was presented verbally without supplemental audio- visual aids. Group B (Experimental) was exposed to the same content using a multimodal presentation. In addition to the lecture presentation, overhead transparencies, slides, handouts of diagrams and drawings that illustrated key concepts, and three-dimensional models were utilized. The same nurse educator presented the nursing content to Groups A and B.

Method of Analysis

The independent t-test was applied to the mean score (number correct) to validate the assumption that the two groups were comparable at the time of the pretest. An analysis of covariance was applied to the posttest scores using the pretest as a covariate to identify any significant differences in knowledge acquisition between groups (p = .05). The same test was computed for the retention scores using the posttest as a covariate to determine if learning retention was better for either group.

Table

TABLE 1MEAN ACHIEVEMENT SCORES AND STANDARD DEVIATIONS ON PRETEST, POSTTEST, AND RETENTION TEST FOR GROUP A (CONTROL) AND GROUP B (EXPERIMENTAL)

TABLE 1

MEAN ACHIEVEMENT SCORES AND STANDARD DEVIATIONS ON PRETEST, POSTTEST, AND RETENTION TEST FOR GROUP A (CONTROL) AND GROUP B (EXPERIMENTAL)

FIGUREMEAN ACHIEVEMENT SCORES ON PRETEST, POSTTEST, AND RETENTION TEST FOR GROUP A (CONTROL) AND GROUP B (EXPERIMENTAL)

FIGURE

MEAN ACHIEVEMENT SCORES ON PRETEST, POSTTEST, AND RETENTION TEST FOR GROUP A (CONTROL) AND GROUP B (EXPERIMENTAL)

Table

TABLE 2ANALYSIS OF COVARIANCE OF POSTTEST SCORES USING PRETEST AS COVARIATE

TABLE 2

ANALYSIS OF COVARIANCE OF POSTTEST SCORES USING PRETEST AS COVARIATE

Table

TABLE 3ANALYSIS OF VARIANCE OF RETENTION SCORES USING POSTTEST AS COVARIATE

TABLE 3

ANALYSIS OF VARIANCE OF RETENTION SCORES USING POSTTEST AS COVARIATE

Results

The independent t-test was applied to the mean scores (number correct) to validate the assumption that the two groups were comparable at the time of the pretest. In the (Control) Group A (n = 22) correct scores ranged from 16 to 28, while the (Experimental) Group Bin = 21) had correct scores ranging from 13 to 34. The computed ? value was .75 which was not statistically significant. Mean achievement scores and standard deviations were computed on the pretest, posttest, and retention test scores for both groups as illustrated in Table 1.

Mean number of correct answers for both groups was graphed to compare the incline and decline slope between the pretest and posttest, and posttest and retention test (Figure).

An analysis of covariance applied to the posttest scores used the pretest as a covariate to determine if knowledge acquisition was better for either group. Group A (Control) scores ranged from 34 to 48 on the posttest while Group B (Experimental) scores ranged from 35 to 46. (See Table 1 for means and standard deviations.) The computed ? value of .09 was marginally significant but not at the .05 level required. This computation indicated that neither group initially acquired knowledge significantly better than the other as shown in Table 2.

An analysis of covariance was applied to the retention scores using the posttest as a covariate to determine if learning retention was better for either group. Group A (Control) had retention scores ranging from 29 to 42 while scores of Group B (Experimental) ranged from 28 to 47. (See Table 1 for means and standard deviation.) The computation determined that the mean retention score for Group B (Experimental) was significantly higher than for Group A (Control) at the .03 level; thus, Group B (Experimental) retained knowledge of the content significantly better than Group A (Control). This is depicted in Table 3.

Discussion

Hypothesis 1 was not supported. The statistical analysis of the data revealed no significant difference between the control group (those exposed to the monomodal teaching method) in the amount of knowledge initially acquired, it should be pointed out that while Group A (Control) scored higher on the posttest, they also scored higher on the pretest. The mean posttest score of Group A (Control) increased 19.23 points over the pretest score, but Group B (Experimental) only increased 17.33.

The lack of significantly greater knowledge initially acquired by the multimodal sensory (MLS) experimental group B does not uphold the findings of Rankowski and Galey (1979) and Jensen and Knauff (1977). The results of this study, however, do uphold the findings of Huckabay, et al. (1977) and Schorow, et al (1971). These nursing studies demonstrated no significant difference in learning secondary to the use of audio-visual aids. For this investigation, similar results were obtained as the addition of the visual and tactile stimuli did not increase the amount of knowledge initially acquired.

Hypothesis 2 of this study was supported. The statistical analysis of the data revealed a significant difference between Group A and Group B in the amount of knowledge retained after three weeks when differences in posttest scores were considered. It should be noted, that while Group A (Control) scored higher on the posttest, they subsequently scored lower on the retention test. In contrast, there was less variation in the mean score of Group B (Experimental) on both tests. The mean score of Group A (Control) decreased 7.41 on the retention test while the mean score of Group B (Experimental) decreased only 3.95, or approximately half that of the control group. The significantly greater amount of knowledge retained upheld the beliefs of Heidgerken (1944) and the research of Siegel (1973). The use of audio-visual aids during lecture apparently affected the storing phase of knowledge and made it more readily available for retrieval three weeks later. This may account for less variance of scores on the posttest and retention test and a higher overall retention score.

Implications for Nursing

The results of this study demonstrated that under normal classroom conditions, knowledge acquisition may not be significantly affected by the use of audio-visual aids, but retention can be significantly increased; thus, the use of audio-visual aids may be an effective teaching method that increases the amount of knowledge retained. If educators continue to use lecture presentation as a primary teaching method, consideration should be given to improving its quality. This means that teachers should become adept in the preparation and appropriate use of audio- visual materials that will enable greater learning and retention of information for future use. Generally, nursing instructors have not had academic preparation in designing, preparing, and testing the effectiveness of audio- visual media to augment the teaching-learning process in nursing. Thus, the development and use of media should be emphasized as a means to supplement the efforts and skills of instructors. Media will not replace the instructor; instead, it can be used to improve the quality of learning. Formal courses or workshops which would provide faculty with the opportunity to develop skills in the preparation and use of audio- visual media should be made available to nursing instructors. Even though media development can be a costly line item - time, energy, and money - deans and directors of educational programs should consider budgeting monies explicitly for the development and use of media in addition to the faculty development workshops.

Faculty need to be given adequate preparation time, supplemental services, and supplies to promote utilization of more effective teaching methods; furthermore, nursing faculty should continue to examine the relationship of various strategies and their effects on learning and retention. This study demonstrates that retention is significantly increased by appropriate use of multimodal sensory teaching strategies, therefore, it is imperative that teachers be prepared as instructors as well as subject matter specialists. To ensure that this preparation exists, employers of nursing instructors should examine credentials in teaching as a part of the interview process to help ensure effective teaching/learning.

Suggestions for further Study

The findings indicate a need for additional research related to the teaching/learning process with attention given to ascertaining what kind of media enhances learning, under what conditions, and for what clinical courses. Further development of this study could examine the relationship of clinical performance and demographic variables to knowledge acquisition and retention. Additional research could detennine if there is a correlation between admitted sensory preference and use of multimedia and its effect on learning outcomes. Studies exploring the relationship between type and complexity of material to be learned and type of media used also need to be constructed.

References

  • Bevis, O.E. (1978). Curriculum building in nursing. St. Louis: The CV. Mosby Co.
  • Broadbent, D.E. (1958). Perception and communication. Condon: Pergamon Press.
  • Gagne, R. (1970). The conditions of learning. New York: Holt, Rinehart, & Winston.
  • Heidgerken, L. (1944). Films in the teaching of science. American Journal of Nursing, 44(5), 483-485.
  • Hsia, H.J. (1968). Output, error, equivocation, and recalled information in auditory, visual, and audiovisual information processing with constraint and noise. A V Communication Review, 16(3), 245-267.
  • Huckaby, L., Cooper, P., & Neal, M. (1977). Effect of specific teaching techniques. Nursing Research, 28(4), 316-317, 380-385.
  • Jensen, W., & Knauff, R.L. (1977). Programmed multi-image lectures for college biology instruction. Journal of Science Teaching, 6(3), 159-163.
  • Menne, J. & Menne, J. (1972). The relative efficiency of bimodal presentation as an aid to learning. A V Communication Review, 20(2), 170-180.
  • Mouly, G. (1968). Psychology for effective teaching. Atlanta: Holt, Rinehart & Winston.
  • Rankowski, C, & Galey, M. (1979). Effect of multimedia in teaching descriptive geometry. ECTJ, 27(2), 114-120.
  • Ryan, T.A. (1940). Interrelations of sensory systems in perception. Psychological Bulletin, 37(1), 659-698.
  • Schorow, W.M., Osborne, J, & Kelsey, H. (1971). Training nurses for coronary care practice. Nursing Outlook, 19(2), 95-97.
  • Siegel, H.B. (1973). McLuhan, mass media, and education. The Journal of Experimental Education, 41(3), 68-70.
  • Thompson, M. (1972). Learning: a comparison of traditional and autotutorial methods. Nursing Research, 21(5), 453-462.
  • Watts, P. (1976). Comparison of three human sexuality teaching methods used in university health classes. The Research Quarterly, 48(1), 187-190.

TABLE 1

MEAN ACHIEVEMENT SCORES AND STANDARD DEVIATIONS ON PRETEST, POSTTEST, AND RETENTION TEST FOR GROUP A (CONTROL) AND GROUP B (EXPERIMENTAL)

TABLE 2

ANALYSIS OF COVARIANCE OF POSTTEST SCORES USING PRETEST AS COVARIATE

TABLE 3

ANALYSIS OF VARIANCE OF RETENTION SCORES USING POSTTEST AS COVARIATE

10.3928/0148-4834-19840101-06

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