Journal of Nursing Education

Research Briefs 

Nurse Educators Teaching Through the Lens of Transformative Learning Theory

R. Oscar Bernard, PhD, RN

Abstract

Background:

The study purpose was to explore the experiences of nurse educators when teaching undergraduate nursing students through the lens of transformative learning theory.

Method:

This qualitative case study used interviews of 11 nurse educators who employ teaching strategies developed from the perspective of transformative learning theory. Multiple data sources were added to the study to enhance credibility of the findings: two program administrator interviews, qualitative surveys for 97 nursing students, five classroom observations, and records review.

Results:

Using inductive analysis, the data collection revealed five prominent themes: Stepping Off the Stage, Teaching Outside the Box, Finding the Balance, Who's in Charge?, and Seeing Is Believing.

Conclusion:

The five themes provided insights into a previously unknown phenomenon in nursing education. The use of transformative learning strategies by this group of nurse educators illustrated innovative approaches to enhance teaching effectiveness, optimize student learning outcomes, and achieve the level of transformation nursing graduates need to successfully perform in the complex health care environment. [J Nurs Educ. 2019;58(4):225–228.]

Abstract

Background:

The study purpose was to explore the experiences of nurse educators when teaching undergraduate nursing students through the lens of transformative learning theory.

Method:

This qualitative case study used interviews of 11 nurse educators who employ teaching strategies developed from the perspective of transformative learning theory. Multiple data sources were added to the study to enhance credibility of the findings: two program administrator interviews, qualitative surveys for 97 nursing students, five classroom observations, and records review.

Results:

Using inductive analysis, the data collection revealed five prominent themes: Stepping Off the Stage, Teaching Outside the Box, Finding the Balance, Who's in Charge?, and Seeing Is Believing.

Conclusion:

The five themes provided insights into a previously unknown phenomenon in nursing education. The use of transformative learning strategies by this group of nurse educators illustrated innovative approaches to enhance teaching effectiveness, optimize student learning outcomes, and achieve the level of transformation nursing graduates need to successfully perform in the complex health care environment. [J Nurs Educ. 2019;58(4):225–228.]

The gap in knowledge about nursing instructors' experiences using teaching strategies from transformative learning theory with undergraduate nursing students is addressed in this study. Review of the research literature on teaching strategies derived from transformative learning theory indicated that these strategies contributed to helping learners achieve the emancipatory knowledge needed for professionalism (Hodge, 2014). It was also clear from the research that reform in nursing education science was needed to provide interactive teaching–learning approaches that prepare nursing students for the complex health care environment (Benner, Sutphen, Leonard, & Day, 2010). Although many studies from disciplines other than nursing education provide the educators' perspective of experiences using teaching strategies from transformative learning theory, there was a dearth of studies in the nursing education literature about nursing instructors' experiences with transformative teaching strategies (Morris & Faulk, 2012). The studies in nursing education focused on the perception of students' experiences with transformative learning strategies, and the authors in these studies recommended further research on teaching strategies derived from transformative learning theory (Faulk, Parker, & Morris, 2010; Foronda & Belknap, 2012; Hanson, 2013; Jackson, Power, Sherwood, & Geia, 2013; Ruth-Sahdm Beck, & McCall, 2010; Sedgwick, Oosterbroek, & Ponomar, 2014). Adding this study to the body of knowledge provides nurse educators with additional information as they decide which evidence-based practices can best achieve nursing students' learning outcomes.

A meta-analysis completed in 2007 determined that transformative learning theory has become one of the most researched adult learning theories (Taylor, 2007). This observation has been further supported by an extensive literature review in the Education Resources Information Center (ERIC) database revealing 380 peer-reviewed articles published on transformative learning since 2010. Teaching strategies derived from transformative learning theory can provide the tools instructors need to help nursing students achieve the clinical reasoning skills required in today's complex health care environment (Ruth-Sahd et al., 2010). An example of this type of teaching strategy to enhance clinical reasoning is role-playing, whereby a disorienting dilemma introduced in a case study helps students to use reflection and discourse. Transformation occurs as the learners explore both the cognitive and affective skills needed to determine priority assessments and interventions to quickly solve the identified patient problem.

These types of innovative approaches also support the National League for Nursing (NLN) initiative to reform nursing education by identifying and evaluating teaching strategies that enhance nursing students' ability to think critically (NLN, 2015). Therefore, the research question in this study was “What are the holistic experiences nurse educators had when teaching undergraduate nursing students through the lens of transformative learning theory?” The research question was especially significant because a gap remains in the nursing education literature on how strategies from transformative learning theory are being used with nursing students. In addition, no qualitative study has been published in the past 7 years that explores the use of transformative learning theory from the perspective of the nurse educator. The reason nursing studies on transformative learning have been from the student perspective instead of the educator perspective may be because nursing education has not accepted the validity of transformative learning theory. On the contrary, the popularity of primary studies from educators' perspectives outside of nursing education suggests a more generalized acceptance of the value of the theory to enhance learner outcomes.

Mezirow developed transformative learning theory from his seminal study in 1975 (Mezirow, 1978). Mezirow discovered that transformation occurred when an individual explored and evaluated frames of reference (Mezirow, 1996). Frame of reference is the series of assumptions used to provide understanding of experiences. These assumptions create the expectations, perceptions, thoughts, and feelings about an experience. The frame of reference examined in this study was nurse educators' assumptions about the role of the teacher. On the basis of the literature, most nurse educators have assumed that the primary role of the teacher is to transfer knowledge to the learner via a traditional lecture format (Gardner, 2014). For educators teaching through the lens of transformative learning theory, the primary role is to facilitate the students' ability to construct knowledge using innovative student engagement activities (Faulk et al., 2010).

Method

A qualitative case study was used for this research to describe nursing instructors' experiences with teaching strategies based on transformative learning theory. The site of the study was an accredited nursing program in the United States with 18 undergraduate faculty members who teach through the lens of transformative learning theory. Eleven of the faculty agreed to participate in the research. The demographics of these educators included an average of 35 years working as nurses, 17 years teaching nursing students, and 9 years using strategies based on transformative learning theory. The educators' use of transformative learning theory was validated by several criteria: university and nursing mission statements that reflect the importance of the theory in all courses, training the educators received from the university, measurement of transformative learning outcomes performed by the university's designated center of transformative learning excellence, content included in the interviews, review of the syllabi, observations in the classroom, and student surveys.

To optimize the credibility of the case study, multiple sources of data were added to the educator interviews. These additional sources included interviews of the two nursing program administrators who have overseen the nursing program for 8 years. These managers expressed the expectation for nurse educators in the program to implement transformative learning strategies. The researcher also completed five classroom observations. At the end of the observations, the researcher distributed qualitative surveys to the 201 students present in the class sessions. Of these students, 97 volunteered to complete the surveys. The students represented cohorts from the first, second, fourth, and fifth semesters of the five-semester program. Records review of mission statements, vision statements, and syllabi were also included in the data collection.

Thirteen nurse educator interview questions were developed to reveal the stories of the nurse educators' experiences with transformative learning theory. These interview questions included exploration into how the educators discovered teaching approaches derived from transformative learning, experiences they have had using the strategies in the classroom, specific approaches they have found successful and unsuccessful, and how they communicate their experiences with their education colleagues. In addition, six interview questions were designed for the program administrators to provide additional insights into the phenomenon. The researcher followed an observation protocol with five classroom sessions to add field notes to the data collection process. The final instrument designed for the study was a five-question qualitative survey offered to the 201 students who participated in the five class sessions, whereby 97 students volunteered to answer the survey.

After receiving institutional review board approval, data were collected at the university for 5 days. The face-to-face interviews averaged 60 minutes in length. Each classroom observation lasted from 1.5 to 3 hours. At the end of the class session, the students received the survey. After analysis of all interviews was completed, categories from the interviews were combined to determine the overall themes that were common throughout the data collection. The field notes from the observations were compared with the data analysis of the interviews to discover similar concepts. The analysis of the data was corroborated with another qualitative researcher acting in the capacity of dissertation mentor.

Triangulation was provided through the document analysis of the program mission and philosophy statements, the course learning objectives and outcomes, and the syllabi descriptions of learning activities designed for transformative learning. The final step in the data analysis procedure was review of the student surveys. This provided an additional layer of triangulation to enhance credibility of the data collection. The data analysis from the administrator interviews, classroom observations, student surveys, and records review significantly matched the themes established from the educator interviews. Most remarkably, all but five students who completed the student surveys expressed an appreciation of the educators' use of transformative learning strategies because it related to the learners' goals of becoming effective and competent nurses.

Results

The inductive analysis of the data collected in the case study using constant comparative methods revealed five prominent themes: Stepping Off the Stage, Teaching Outside the Box, Finding the Balance, Who's in Charge?, and Seeing Is Believing.

Stepping Off the Stage

The following quotation provides an insight into the reasons why participants stated they made the decision to use activities derived from transformative learning theory:

I was prompted to change when I was using slides and read the content, the students in their evaluations asked me not to read to them. At that time, I did not know any other way to do it. A colleague was working on her PhD and focused on problem based-learning, which then impacted me. Then I started making the transition. The literature was showing that students don't learn from traditional lecture. But I did not know how the students were going to learn the content if I was not telling it. So, it took a while for me to transition into this belief that they could learn in different ways of teaching.

This quotation, and others like it, was used to develop the theme Stepping Off the Stage because the educators discussed developing teaching styles that were not the “sage on the stage” using a passive lecture approach. They said in the interviews that the students were memorizing content from the lecture but they were not applying the content. By using active-learning strategies, the participants achieved increased success with student learning outcomes and a higher level of teaching satisfaction. A common example shared by all participants was group discussions about complex patient scenarios where the teacher was able to circulate throughout the classroom listening and providing assistance as students discovered their own solution to the patient problems. The educators made this transition through trial and error, by watching other educators who used transformative learning strategies, and from information they learned in the literature.

Teaching Outside the Box

When discussing their experiences using transformative learning activities in the classroom, three educators said:

  • I tell them my goal is not just good grades but for them to grow personally in the class; that is my expectation. They must look at themselves to grow.
  • With group work the students are able to absorb the content better. I do activities that help bring variety and interest. Some students transform and some do not.
  • Part of transformation is creating a disorienting event to help students reflect on the challenges of nursing. That happened in class yesterday and then I will build on it to create deep learning.

From these insights, the theme Teaching Outside the Box emerged because the educators repeatedly shared examples of creative ways to enhance the classroom experience. They explained that this creativity mainly came from their own experiences, but they also got ideas from observing their colleagues, from the literature, and from workshops provided at their university. The participants also stressed that the development of these creative lesson plans were time consuming, but after the activities were established they could be used from one semester to another. Examples of these activities described in the interviews and seen in the classroom observations included role-playing, case studies, group discussions, journal reflection, gaming, disorienting dilemma situations, creative writing, artwork interpretation, reflection and discourse of firsthand patient stories, concept mapping, and care planning.

Finding the Balance

An additional theme emerged when the educators reflected on their discovery of balance between information transfer and engagement activities in the classroom:

  • I make sure that all the activities I use in the classroom is pertinent for their learning needs. None of it is busy work.
  • A good transformative learning experience is not all activities, but also some lecture. I think classroom activities can be overdone, then the body of knowledge can be lost; we can't just play. I call it content presentation instead of lecture.
  • Nursing is overwhelming. We are trying to teach them strategies to help them cope with these challenges. If we can't help them during the program, they will graduate without the ability to cope with the complex priorities of health care. They have a lot to learn and we need rigorous activities, and we need to be committed to helping them achieve those expectations.

Each educator stressed that the engagement piece of transformative learning strategies is critical for achieving student outcomes. Nonetheless, they also stressed the importance of giving the students information dispersed between and within the activities.

Who's in Charge?

This theme represents the importance of student buy-in and the role of the educator to help the students understand why transformative learning activities are used in the classroom. The following quotes illustrate the importance for the teaching expert to be in charge of the learning experience:

  • I am intentional in explaining to the students how I tie together what I am doing in the class with the course content and objectives. They need you to tell them how it is related to the transformative learning activities.
  • Number one, you have to demonstrate trust. You have to be upfront, treat everyone fairly, don't tell them one thing and then do another. Some teachers don't do that. I also do a lot of sharing of my personal experiences, so they can see that I am vulnerable too.
  • My teaching philosophy is to get to know the students, because if you get to know them, they will be more likely to come to you if they have problems. So, I don't like to stand up there and teach at them; I want it to be a collaborative experience between the teacher and the student.

Within this theme, the educators discussed taking the mystery out of deep learning. They stressed that the students are not experts in learning, but the educators should be. It was also mentioned that many instructors try to do what the students want because of the influence student evaluations have on instructor performance assessments. Nonetheless, the participants stressed that teachers need to help the students understand the reasons for deep learning, and in this way the instructor is in charge of the transformative learning by helping the students discover how transformation occurs. Trust and student preparation prior to class were important concepts within this theme.

Seeing Is Believing

The educators frequently mentioned their opinions on the best way to help other nursing instructors understand transformative learning strategies. The following quote summarizes the overall agreement the participants shared concerning this theme:

Come to my class and watch and look and see, because I think until you experience transformative learning you just don't know.

Other important concepts in this theme included discourse with their peers about adult learning theory, sharing stories of how satisfying the transformative learning approaches are for both the instructor and the students, and participation in presentations about transformative learning theory.

Conclusion

The purpose of this qualitative case study was to explore the holistic experiences of nurse educators when teaching undergraduate nursing students through the lens of transformative learning theory. An effort was made to fully capture the stories of the 11 nurse educators teaching in an accredited nursing program in the United States. These stories shed light on a relatively unknown phenomenon within nursing education. Although designed for an audience within the field of nursing education, the insights gained in the data collection and analysis may also benefit any higher education instructor seeking innovation in the classroom.

The findings from the study included the transformation each educator experienced as they discovered that their previous methods of passive instruction through traditional lecture formats were not meeting the needs of the nursing students and nursing program. The description of their transition into active learning strategies that brought the educators off the stage and into facilitated learning was dramatic and enlightening. In addition, their explanation of student buy-in and creatively designed innovative activities provided a road map for success. The educator interviews were combined with multiple other sources of data in the case study to enhance the reliability of the findings and improve rich description of the educators' experiences.

Prior to this study, there was a gap in the literature on nurse educators' experiences teaching through the lens of transformative learning theory. This gap was astounding given that transformative learning theory has been one of the most researched adult learning theories in the past 15 years (Taylor, 2007). Bringing the stories of these nurse educators to light helped reveal the use of transformative learning—an intervention that is consistently spreading within higher education but is still relatively unknown in the discipline of nursing education (Morris & Faulk, 2012). The findings of the study are timely when considering the ongoing call in the past 7 years for nurse educators to consider innovative approaches to improve nursing student outcomes (Benner et al., 2010). The use of transformative learning strategies by this group of nurse educators demonstrated an innovative approach to enhance teaching effectiveness, optimize student learning outcomes, and achieve the level of transformation nursing graduates need to successfully perform in the complex health care environment.

A recommendation for further research is to replicate the study using a sample selection from numerous nursing programs instead of one program. Given that the university used in this study fully supports and utilizes transformative learning theory in all departments, educators from nursing programs without this level of support will likely have different experiences. Another recommendation for further research came from frequent statements by the educators interviewed in this study. Each educator stressed that they did not learn about adult learning theory in their graduate nursing education programs. Future research into the reason that nursing education has not been incorporating the evidence and recommendations from adult learning theories could help hasten the radical transformation needed to improve nursing student outcomes.

References

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Authors

Dr. Bernard is Director of Accelerated Second Degree Major, University of South Florida, College of Nursing, Tampa, Florida.

The author has disclosed no potential conflicts of interest, financial or otherwise.

The author thanks the faculty at Capella University and especially his dissertation mentor, Joy Bailey, for guidance and expertise provided.

Address correspondence to R. Oscar Bernard, PhD, RN, Director of Accelerated Second Degree Major, University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC 22, Tampa, FL 33612; e-mail: bernardoscar@yahoo.com.

Received: October 29, 2018
Accepted: January 09, 2019

10.3928/01484834-20190321-07

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