Self Directed And Life Long Learning

1 January 2017

The purpose of this essay is to explore and evaluate an aspect of teaching and learning and the following topic of; ‘self-directed/lifelong learning’ is the authors chosen subject. This essay will determine knowledge of this chosen aspect of teaching and learning, critically evaluate the concept of self directed and lifelong learning from the authors own perspective an a nurse educator.

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The essay will also identify and consider challenges that arise in the application of self-directed and lifelong learning, identify areas where this chosen topic will assist in bridging the theory practice gap, as well as identifying outcomes for patient/client care. The central question of how adults learn has occupied the attention of scholars and practitioners since the founding of adult education as a professional field of practice in the 1920’s.

Some eighty years later, we have no single answer, no one theory or model of adult learning that explains all that we know about adult learners, the various contexts where learning takes place, and the process of learning itself. What we do have is a mosaic of theories, models, sets of principles, and explanations that, combined, compose the knowledge base of adult learning. Two important pieces of that mosaic are andragogy and self directed learning (Merriam, 2001). Knowles (1980, p. 47) proposed a programme planning model for designing, implementing, and evaluating educational experiences with adults.

Knowles suggested that the adult classroom climate should be one of “adultness,” both physically and psychologically. In an “adult” classroom, adults “feel accepted, respected and supported”; further, there exists “a spirit of mutuality between students and teachers as joint enquirers”. And because adults manage other aspects of their lives then they are also capable of directing, or at least assisting in planning their own learning. Knowles himself came to concur that andragogy is less a theory of adult learning than “a model of assumptions about learning or a conceptual framework that serves as a basis for an emergent theory” (1989, p. 12).

This acknowledgement by Knowles resulted in andragogy being defined more by the learning situation than by the learner. About the same time as Knowles introduced andragogy to North American adult educators, self-directed learning appeared as another model that helped define adult learners as different from children. Based on the pioneering work of Houle, Tough, and Knowles, early research on self-directed learning was descriptive, verifying the widespread presence of self-directed learning among adults and documenting the process as it occurred (Merriam, 2001). Houle, 1996, p. 29) stated that what is significant is that andragogy has alerted educators to the fact that they “should involve learners in as many aspects of their education as possible and in the creation of a climate in which they can most fruitfully learn”.

What Merriam and Caffarella (1999) term “instructional “ models of the process focus on what instructors can do in the formal classroom setting to foster self-direction and student control of learning. Historically, in relation to nursing education, the term learner-centred education did not appear frequently.

This may have been attributed to the previous accepted nursing curriculum and prejudice against higher education, as evidenced by stereotyped cliches such as ‘nurses are born not made’. Advocates of the ‘hidden curriculum’ in nursing education (Clinton 1982, Crout, 1980) extended the argument to reason that nurse educators ‘de-emphasise’ the theoretical basis of nursing since they seek to train learners to become conformist, non-critical and obedient employees. (Sweeney, 1986).

However nurse training did move into higher education, a move born of a desire to increase the ‘professionalism’ of nursing. As the author is a nurse educator within the mental health service area of a district health board, and there is a specific need and desire to both explore and evaluate self-directed/lifelong learning from a mental health educational viewpoint. The author also trained in Scotland in the 1980’s and was trained the traditional hospital apprentice model.

Therefore the concept of self-directed /lifelong learning will be explored from my own experiences of learning, both in a pre-registration environment and over the span of my 20 year post qualifying period. In charting the development of lifelong learning as a concept and taking stock of its current location in nursing, one of the prominent elements noticed has been the proliferation of documents in the 1990’s emphasizing the value and the modes of implementation of lifelong learning in general as well as in nursing (Gopee, 2001).

In the UK, the government’s nursing strategy document, Making a Difference (DoH, 1999) notes that ‘Lifelong learning is more than a slogan, and access to education, training and development is no longer an aspiration for the few but a necessary part of jobs and careers in most sectors’. The UK nurses’ professional body the Royal College of Nursing (1997) asserts that continuing professional development (CPD) should be seen ‘as a way of life’.

Knapper and Cropley (2000) suggest that the term lifelong learning may be no more than a ‘unifying principle’ that links existing trends and tendencies in education. In other words lifelong learning takes a more holistic perspective, and should be a normal and realistic expectation throughout life. Certainly from the authors’ perspective, much has changed since the pre-registration days of my nurse training, whereby the UK was on the precipice of moving from an institutionalised model of care to a community based model and all that this entailed.

The nature of mental health nursing delivery in the Western world, like all areas of health care, continues to undergo profound changes (Barling and Brown, 2001; Ryan-Nicholls, 2003). These changes – shifting client populations, case management, changing loci of care (e. g. , from hospital to community) and competing models of care – have impacted upon the practice of mental health nursing. In addition, educational provision for mental health nurses has had to address issues of change in recruitment, retention, career opportunities and practice development (Happell, 2001; Hannigan 2004).

Additionally in Australia and New Zealand direct entry to mental health nursing was phased out by the mid 1990s. Despite the passage of time, there remains concern that mental health nursing has not been well served by this change in educational preparation (Happell, 2008a,b). Along with the reported shortage of mental health nurses, there has also been a decline in the number of graduates choosing a career in mental health nursing (Curtis, 2007) with relatively small numbers undertaking postgraduate study in this specialist area (Happell and Gough, 2009).

Unlike Australia and New Zealand, the UK continues an undergraduate mental health nursing programme and anecdotal evidence would suggest that the problems of recruitment and retention in mental health nursing are more problematic on this side of the globe. Happell’s (2001) Australian study of almost 300 students showed that initially mental health was not a popular choice amongst undergraduate nursing students but, nevertheless, suggests that clinical experience in mental health settings modifies such erceptions. Educational provision beyond initial registration demonstrates the potential for, as well as the challenges, of continuing professional development for this group of nurses (Robinson and Tingle, 2003). One educational provision is to enhance the practice of particular mental health nursing skills. The use of particular psycho-social interventions, via such initiatives as the Thorn programme, has been highlighted in caring for clients with enduring mental health problems (Gamble, 1997).

The author of this essay is a strong advocate for such programmes being introduced into a New Zealand post graduate mental health nursing programme, as she herself completed this programme over a 12 month period at the Maudsley Hospital in London. This programme recognised that whilst the UK has maintained an undergraduate mental health nursing programme, gaps continued to remain in nursing and other disciplines in the provision of adequate care for clients with enduring mental illness and their families.

The Thorn programme aimed to minimise those gaps in the UK mental health service provision by ensuring that nurses and other disciplines had the necessary skills to meet those needs. As a nurse educator within the mental health services of a District Health Board in New Zealand, the role includes mandatory educational responsibilities for both nursing and allied health staff, within the provider arm and non-government organisations. The role extends to providing non-mandatory education to colleagues and this includes; enduring mental illness, clinical supervision, preceptor training, to name but a few.

Also included is involvement in our New Graduate Mental Health Nursing Programme. This variety within my role can and does present both opportunities and challenges when attempting to foster and encourage new learning’s, and influence change. The challenge therefore is acknowledging the wide ranging experience and qualifications that learners have and creating an environment in which the participants and my role support both as being joint enquirers.

Therefore whilst I believe my role as educator is not from a hierarchal model, rather one based on being learner centred and inclusive, I am also aware that at times my style of teaching can be more of a didactic model, however I encourage class participants to also share their own learning’s and experiences. I do however find myself wanting to impart as much knowledge as I can, and I believe some of this is fuelled by my own training and experiences and my on-going concerns that New Zealand does not have an ndergraduate mental health nursing programme.

Having reviewed the many studies by Brenda Happell on the similar Australian comprehensive undergraduate nursing programme and the recruitment and retention issues within mental health nursing, I find myself concerned, especially for the future of mental health nursing and the ability to attract and retain our mental health colleagues. This however may serve to promote a more didactic teaching style and this is one of the challenges for me to remedy as a nurse educator.

The educator role also includes our regular work-force, both registered and unregistered staff, therefore another challenge is to both promote and maintain good clinical understanding of mental health issues that impact our client group and their families, and keeping staff abreast of changes and national strategies and directives. Another challenge is that some attendees at mandatory training and continual professional development training are not there through choice, but rather because their managers have told them to attend and/or they require additional educational and professional development hours for their annual registration.

A UK study by Gould et al. , (2007) on nurses’ experiences of continual professional development (CPD), five main themes emerged from the data: Who and what is CPD for? Accessing CPD; One size does not fit all; Managing work, life and doing CPD; and Making the best of CPD. The respondents in this research thought that CPD played an important role in enhancing service provision and maintaining safety for patients and nurses, and made links between CPD and clinical governance as well as bridging the theory practice gap.

The importance of maintaining skills, remaining professionally updated and CPD was also considered to play a key role in both career and personal development. A fewer number of respondents expressed a view that ‘nursing had lost its way’ by becoming overly academic. They called for a return to traditional values, when much greater importance was placed on clinical experience. On the subject of managing work, life and CPD, some respondents complained of the expectation that they would invest personal time in CPD intended to primarily improve service delivery.

This resulted in considerable resentment, especially when individuals were already feeling the effects of heavy clinical workloads, poor staffing and the rapid pace of change within the health system. Many of the opinions expressed corroborate the findings of other studies. Poor staffing levels and the absence of colleagues to provide ‘backfill’ was the same problem as in earlier reports (Shields, 2002) and as in the study by Gould et al. , 2004b, there was a feeling from some respondents’ that longer courses with academic emphasis were being promoted at the expense of those intended primarily to attain competency in clinical skills.

From the authors own experience both as a clinician and as an educator, I would concur with the study findings and therefore, ongoing evaluation of my role and the content of the education being delivered, and how it is delivered is of paramount importance. One of the main objectives of the educator role is to identify the theory practice gap and how this can be reduced, in order to enhance the clinical outcomes for our clients and families, as well as creating job satisfaction, confidence and competence within our staff who deliver our mental health services.

In general terms, the theory- practice gap can be defined as the discrepancy between what student nurses are taught in a classroom setting – the theoretical aspects of nursing – and what they experience on clinical placement – the practice of nursing (Jones, 1997). In the late 1980s, as a result of recommendations made in Project 2000’ (UKCC, 1986), nurse education in the UK moved from hospital-based schools of nursing into universities. Exposure of nursing students to the research-based education of universities was perceived as a way of fostering critical, analytical practitioners, capable of applying research to practice.

However, there is contention that degree programmes focus on theory and research to the detriment of practice experience. Thus graduate nurses are accused of lack of competence when they first qualify (Roberts and Johnson, 2009). This is an accusation seldom if ever targeted at any of the other graduate professions within healthcare. For nurse education then, it is crucial that graduate programmes combine theoretical and practical learning and develop strategies to ensure that the competency of newly qualified nurses is assured (Taylor et al. , 2010).

However changes to competence assessment in nursing have not been without its critics. Following a systematic review of the literature, Watson et al. , (2002) argued that there was no evidence to support the use of competency-based nurse education. Moreover, they asserted that while not wrong in itself, competence driven nurse education may be misguided because it encapsulates an ‘anti-education’ mentality’. Such is the complexity of competence assessment, that not even involvement of mentors in the process is unproblematic. Mosely and Davies (2008) reported that mentors often struggle with the cognitive demands of the role.

Moreover, there are a number of organisational and contextual constraints that make assessment difficult. Lack of time is identified as a major constraint (Myall et al. , 2008; Wilkes, 2006). The problem is compounded by increased student numbers that impinge on placement provision and put mentors under pressure (Murray and Williamson, 2009). Additionally, there is lack of recognition for mentors (Bray and Nettleton, 2007; Kilcullen, 2007) and the inherent role confusion inherent in simultaneously acting as mentor and assessor (Bray and Nettleton, 2007; Wilkes, 2006).

A UK study conducted by Corlett (2000), attempted to explore and identify the perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap in nurse education. This study identified that without exception, interviewees felt a theory-practice gap does exist, with students saying it was huge, whilst teachers thought it was probably fairly narrow. Some teachers felt the gap was a beneficial phenomenon, encouraging students to develop problem-based learning and reflective skills to overcome the gap. Students viewed the differences as frustrating and gave more credence to what they saw and learned on placement.

Whilst the study identified that preceptors played an important role in helping students relate theory to practice, interviewees felt there was little time to facilitate this process due to the shortness of placements – a finding supported by several other studies (Richards, 1993, White & Riley, 1993, Philips et al. 1996). Several studies have also identified that nurse teachers are seen to teach an idealized version of nursing, which often did not fit with the realities of practice. Nurse teachers’ credibility is also lessened when students report what they had seen in the clinical area was different to what they had been taught.

Sequencing theory and practice appears particularly worrying for students with the academic model and the role of nurse educators being far removed from reality, therefore a collaborative relationship between nurse educators, students and preceptors appears to be a potential way forward. Within the mental health services it is hoped that the nurse educator role, whilst based within the hospital setting, allows for some of the theory practice gap to be addressed and reduced, and that our staff who support and preceptor our students and newer staff also feel supported.

In a study conducted by Hallin and Danielson (2010), preceptors who are supported and informed of the university’s expectations of what nursing students ought to achieve and how they should perform are significantly more likely to report and manage students with insufficiencies. However reasons given as to why nursing students with difficulties pass clinical education are primarily RNs’ feelings of guilt, lack of preceptor experience, insufficient time to observe the student, but also feelings of pity for students (Luhanga et al. , 2008b).

Critical decisions on student performance are easier to handle when guidance and teacher support are insured, the structured three-way (tripartite) meetings between teacher, student and personal preceptor described in Hallin and Danielson (2010) model would improve evaluation quality. There is therefore no doubt that there is a need for improved communication, information sharing and collaboration between the tertiary institutions and clinical areas, this would enhance the integration of theory to clinical practice for nursing students , whilst supporting the preceptor in the understanding of the nursing programme.

Other studies report that with high staff turnover and retention issues concerning RNs, lack of time and opportunity to be supported to take a preceptor-preparation course and other educational opportunities to increase RNs own knowledge, high student numbers and preceptors not being given adequate time and resources to spend with students, could increase RNs resentments of feeling overworked and therefore less eager to work with students. Undoubtedly, efforts must be made that ensure being a preceptor is considered an honour and results in benefits and rewards (Hyrkas and Shoemaker, 2007).

In the role as a nurse educator within the District Health Board, preceptors attend a two day training course and there is ongoing education for them to access within our mental health training programme, it is hoped that this therefore minimises some of the negative impacts the research has found. As previously discussed, self-directed/lifelong learning is very much a part of being in the health and specifically the nursing profession, the authors own experience is that to keep abreast of our ever changing health system and how we deliver care now and in the future, nurses have to accept that this is a necessary part of our roles.

There are many advantages to lifelong learning, including enhancement of knowledge of skills, promoting the best quality health services that we can deliver and ultimately improving outcomes for the people we deliver our services to. Life long learning within nursing also gives us the opportunity to bridge the transition from initial training to continuing education, especially important in health and from the author’s perspective in mental health. In the past 20 + years, we have moved to having hospital based care, to community care, this has had a profound impact for both clients and families within the mental health services.

Whilst we acknowledge this has been an advantaged way of delivering care for those clients, it has also meant a huge reliance on families becoming care-givers, therefore to up skill our families; we must understand and up skill ourselves. Our society continues to evolve, just as how we deliver healthcare services continues to evolve, therefore the challenge may not only be the concept of self-directed/ life long learning, but how we ensure that we have robust supports and services in place to meet the needs of our health profession and the needs of nursing, both now and in the future.

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