How many of us have had to expound on a topic in which we feel we lack breadth or depth in an undergraduate class or clinical setting? In situations such as these, most of us would prefer more than library searches and readings as a means to develop a broader base of knowledge for ourselves. Students are very quick to recognize when a teacher's knowledge base is weak or when the teacher is uncomfortable in class. Uncomfortable situations like this may increase if the trend of a declining pool of appropriate nursing applicants at private universities continues to force nursing schools to close or cut back on faculty size (Engelgau, 1984). Making the most effective and efficient use of remaining faculty becomes an even higher priority for nursing school administrators.
One way to enhance the development of a broader base of knowledge for individual faculty is through a peer workshop within a school of nursing. Many areas of nursing lend themselves to this unusual approach, such as, gerontology, women's health, primary care, and psychiatric mental health, to name a few. This article describes one example of how a group of faculty developed, implemented, and evaluated a peer workshop in gerontology. Other educators may find the incentive to initiate such a project.
Three faculty members at the University of Rochester School of Nursing who were prepared in gerontology, pooled their energies and expertise to develop a workshop for their peers on the nursing faculty. These three faculty members identified a need for more knowledge on aging for their peers. To verify the need and develop specific objectives for the workshop, a questionnaire was sent out in the fall semester (after administrative approval) requesting information on their perceptions of a need and areas of interest to them, related to gerontology. The areas identified by faculty surveyed were information on normal aging changes, community resources and curriculum planning to strengthen gerontology content. Thus was born, "Sharing Strategies in Teaching: The Aging Process," a half-day workshop with the following objectives. By the end of the session, participants will: 1) participate experientially in selected teaching strategies, 2) describe the expected outcomes of selected teaching tools to be used with students, 3) identify ways in which teaching methods for gerontology can be incorporated in curriculum development, 4) identify community resources that can be used in working with elderly. The workshop was held shortly before classes were to resume for the spring semester. In this way, few conflicts would arise for both graduate and undergraduate faculty. The workshop was free; notices were sent out one month before the workshop so people could respond. All faculty were invited. Since much of the nursing curriculum is integrated at the University of Rochester, it became even more imperative that as many faculty as possible be reached.
Design and Content
The content was developed from the responses on questionnaires sent out to faculty. The workshop opened with a pretest and an experiential learning activity to explore faculty attitudes and serve as an example of a teaching strategy which might be utilized in student learning activities. Next, there was a presentation and discussion of content on gerontological nursing, teaching strategies and how they might be incorporated into the curriculum, and the impact of attitudes in care of the elderly. Before closing the workshop, community resources available for the elderly were presented and discussed. A summary and post test ended the half-day workshop. A large packet of handouts including an annotated bibliography was given to each participant. Current books, journals, audiovisual catalogues and games related to aging were displayed for participant review prior to and after the workshop session. The workshop was evaluated at two time periods, immediately following the three-hour session and at the end of the spring semester.
Different experiential methods can be used to involve faculty on an affective level. Although evaluation of affective learning is difficult, teaching knowledge without engaging the affective domain may result in ineffective applications of learning. Since nursing faculty are role models to their students, it is important that the faculty demonstrate positive attitudes about aging. In this way the nursing profession itself can be a role model for society. Presently many health professionals have negative feelings about elderly people and the care of elderly.
Experiential exercises include the "Draw Yourself exercise, sensory simulation exercises, and role playing, to name a few. In the "Draw Yourself a participant receives a blank piece of paper and a crayon. Directions are very open, such as "draw yourself as an older person." Allow 10 minutes for drawing. Then each person discusses what is in the picture and its meaning. Facilitators should ask. How old are you? This helps people recognize when they think old age occurs. Through discussion of "What do you look like?" the issue of external signs of aging and normal vs. abnormal age changes can be addressed. The question "What are you doing in the picture?" brings up the ideas of active vs. passive aging, activity vs. disengagement theory, and the continuity of lifestyle as people age. The description of the picture reflects attitudes regarding aging and stereotypes. It is important to allow time for discussion of each participant's picture. That is the rationale for a small group experience.
Sensory simulation exercises involve eye patches to simulate blindness, cotton balls in ears to simulate deafness, and glue on fingertips to simulate loss of fine motor coordination. With these barriers to functioning the participant attempts a task that he or she would normally do. After allowing time for several attempts at task completion, the facilitator then raises the questions, "How did this problem feel to you?" Anger, frustration, stupidity, fear? and "What would have helped you with your task?"
Role playing takes many forms. Two or more people act a pre-determined role. For example, one person is restrained in a chair, the other person helps the restrained individual to drink a cup of water. The facilitator asks "How did you feel" and "What would have helped you?" It is important in all the exercises to allow enough time for full exploration and resolution of feelings.
Several outcomes can be expected from experiential exercises. First, participants increase their sensitivity regarding problems and needs of the aged. Second, participants may increase their insight into behaviors, including so-called problems with older people. Third, the ability to recognize and accept the universality of certain feelings should be improved. Fourth, problem-solving skills around nursing care issues may become more fully developed. Fifth and most importantly, the participant will become more aware of his/ her own feelings and their impact on interactions and interventions with the aged.
Theoretical and Clinical Strategies
Within the theoretical and clinical section of the workshop several areas were addressed: historical perspective, introduction of aging content, attitudes/role models, expected outcomes of teaching strategies, and interdisciplinary resources for learning. Within the historical perspectives, the concepts of why and how care is different for elderly was addressed as well as standards of gerontological nursing practice. Aging content addressed prioritizing topics and sequencing, e.g., normal aging first, then pathological aging. Examples of clinical sites and clinical conferences were presented. Curriculum frameworks were discussed. The source of these frameworks came from material published in The Gerontologist (Johnson, Britton, Lang, Seitzer, Stanford, Yanick, Macklan, Middlesworth, 1980). When attitudes and role models were discussed research findings were shown to validate the points. The expected outcomes from the various teaching techniques were listed. Many are the same that we expected from our workshop. The resources available ran the gamut of individual professionals, to agencies and specific books and journals.
Addressing the area of community resources available for the elderly fulfilled a great need identified through the questionnaire given in the fall. Since over 80% of those over 65 years of age have one or more chronic conditions, it is likely that they will be in need of supportive services to maintain themselves at home. Each community has a network of servi ces; some communities have a dearth of services, others are rich in resources. Nursing faculty who work in various clinical settings need a basis of information to assist students in planning continuity of care, preventing re-hospitalization and enhancing the quality of life for elderly. Because of the complex nature of agencies, payment sources and communities, charts are an excellent teaching tool for covering large amounts of information in short periods of time. One chart that can be helpful is "How to get information about the existence of resources in the community." It can include agencies and specific people and departments.
Another more specific chart can be developed regarding home health agencies in the area. This chart could include the following: agency (name, address, nicknames), criteria for eligibility (age, length of service use, process in hospital to put someone on service ), payment source (insurance coverage), comments (whether for acute or chronic episodes, what is available in the service).
A chart that summarizes and compares and contrasts the state medical assistance program with the federal Medicare program is helpful. This chart could include what the program is, who is eligible for coverage, what services are not covered by each program. For each chart, time should be allotted for participants to ask questions. Highlights from each chart can be reviewed (Stewart, 1979; Furukawa & Shomaker, 1982).
In any learning situation, the nature of the learner, the nature of the material to be covered, and theories of learning need to be considered when planning strategies in the teaching-learning situation. When faculty teach peers, the process of mutual enrichment entails special techniques to avoid pitfalls.
A major pitfall to bear in mind in peer teaching is that the classroom situation may seem threatening to faculty when they are at the receiving end of the teaching. A perceived threat can lead to a defensive posture and a constricted perceptual field (Verduin, Miller & Greer, 1977). In such a situation people do not allow themselves to expand their thinking, but instead maintain themselves as securely as possible. The techniques used in this workshop to avoid defensiveness were the planned informality, the small group setting, the deemphasis on didactic methods, and the very open, supportive responses by workshop presenters among themselves and the participants. This group approach in the teaching format allowed for the interaction of the participants among themselves and the presentors. Through much genuine praise of ideas expressed and approval of participation, the participants were immediately socialized to the norm of participation in discussion and the norm of positive responses to each others' ideas even when they disagreed. Group work has been found worthwhile in effecting change in the affective domain (Verdiun, Miller & Greer, 1977).
Faculty bring a rich source of experience and education to any learning situation. They fall into the category of the adult learner, since they have completed their basic education. Adult learners, especially, need to feel that the material presented is relevant in order for them to become motivated to learn. In addition, new learning should relate to previous learning to increase comprehension and retention.
The material that was presented in the workshop involved cognitive and affective components of learning. The affective domain is most effectively influenced by experiential exercise. A personal view of old age will emerge from the "Draw Yourself exercise (Burnside, Ebersole, & Monea, 1979; Monea, 1976) each person was required to complete at the start of the workshop.
The cognitive aspect of the workshop was addressed mainly through concepts and strategies that could easily be adapted by the participants for use in their courses. Firstly, materials were organized and handouts prepared in a packet of material each received as they entered the room. An outline of the workshop was put on the board as a mind set to begin the time together.
Learning theorists such as Gagne have postulated some effective learning techniques. He discusses the highest form of learning which is the problem-solving type (Gagne, 1977). This learning requires internal thinking which combines previously acquired data to produce a new capability. Each of the previous types of learning must occur in sequence before this final level is reached. Faculty have had such a wealth of education and experience that sophisticated learning takes place quite readily. Through verbal guidance the learner's thinking can be channeled to combine previous learning with other data (both new and previous data). The workshop presenters drew on the talents and education of the participants through probing questions and group problem solving. Once problem solution is reached, it is highly resistant to forgetting (Gagne, 1977).
Many of the suggested learning propositions of Bevis (1973) were included in the workshop techniques. These include: a learner^ need for knowledge, through the questionnaire and optional attendance; cues for problem solving, through ideas and case material presented; movement from familiar to unfamiliar material through active participation, open-ended questions and recall of previous nursing knowledge; reinforcement of desired behaviors; and repetition with feedback. Each presenter had different techniques and data to reinforce attitude change, varied opportunities for application and realistic self-assessment. The self-assessment recommended by Bevis is a part of the evaluation collected at the conclusion of the workshop. The evaluation aids workshop creators as well as the learner.
Since learning, by definition is behavior change, and behavior is influenced by perception, the role of the faculty teaching peers is that of facilitator; she or he facilitates change through re-interpretation of past experiences. Thus, the participants perception oflife experiences and education is gradually modified. Questions are raised about aging, discussed by the group, and reinterpreted by the workshop facilitator. Behavior changes occur over time; the second evaluation questionnaire was sent out at the end of the spring semester in the hope of finding out what behavior changes had occurred.
When peers teach in a faculty workshop, a wonderful opportunity is provided for a mutually rewarding experience. The biggest problem was a lack of time to fully develop all of the content with the participants. A full-day workshop was really needed. Evaluations immediately after the workshop were very positive.
The four-month follow-up evaluations were also positive; we had a return rate of 70% in the latter time period. We had hoped that the workshop would encourage other components within our nursing school to offer similar exchanges in their areas of expertise. This has not come to pass. All of us who came up with the idea, developed the content, and presented the material felt very good about the role we played in maximizing gerontology expertise and promoting positive attitudes about elderly in our school.
Although peer workshops have limitations, especially the lack of depth gained over time in course work, the advantages are many. The time frame is rapid for the learners; the learning is relatively painless and allows for much independent follow-up through annotated bibliographies, discussion, handouts, and tools for teaching. Furthermore, presenters are being recognized for their expertise; preparation time is minimal because the teaching is within their area of expertise and many of the tools and literature are in constant use. It is economically feasible because of the numbers of faculty reached and the resources already available. The positive aspects of the peer workshop coupled with nursing facultys' natural interest and motivation outweigh the disadvantages. The peer workshop becomes an addition to our armamentarium of dynamic and innovative methods for expanding faculty growth and knowledge.
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