Introduction
The present essay will consider the topic of constructive alignment (CA) and apply it to the education of nurses working in Intensive Care Units (ICUs). CA can be viewed as a specific approach to developing educational programs, and it has been evidenced to have some positive outcomes, especially for the quality of said programs (Biggs, 2014; Croy, 2018; Duff et al., 2017). For ICU nurses, education is particularly important because ICU settings have their specific features that require appropriate training (Innes & Calleja, 2018). Consequently, ICU nurses need programs that would facilitate their work by providing them with the necessary knowledge and skills. Given the potential benefits of CA for education, CA needs to be considered in terms of ICU nurse training to determine if it applies to the settings of ICU.
To achieve this outcome, the present paper will begin by presenting the background of CA with particular attention paid to the key features of the approach, its history, and relevance for healthcare education. It will then proceed to critically examine the scope of the literature on the topic and the stakeholders relevant for this review. The impact of CA on ICU nurse education (ICUNE) will be considered next; the related benefits, challenges, and limitations will also be reviewed. Finally, the solutions to the challenges will be proposed. Based on the presented information, a conclusion will be made that due to its benefits and applicability to the ICU context, CA is worth the effort of overcoming its challenges.
Background
Topic Description
Biggs (2014) defines CA as an “outcomes-based approach to teaching.” In practice, it means that learning outcomes are viewed by CA as the first stage of planning. They are the first element of a teaching plan to be stated, and they are used to determine the methods that will be employed. In turn, the methods are viewed as the means of achieving related outcomes and measuring progress. Importantly, the planning must occur before teaching.
Thus, it is apparent why CA is termed as “alignment”: it involves the alignment of teaching and assessment methods with the desired outcomes. However, CA is not limited to outcomes and methods; climate and environment are similarly important (Leigh, Rutherford, Wild, Cappleman, & Hynes, 2013; Turjamaa, Hynynen, Mikkonen, & Ylinen, 2018), as well as the rules and procedures of educational institutions that host the teaching activities (Croy, 2018). Paskevicius (2017) also points out the significance of learning materials. Thus, CA may be defined as the approach to teaching that focuses on the alignment of the various components of the teaching process to create the best and most useful learning experience.
Consequently, it should also be mentioned that the first part of the term CA refers to constructivism. Constructivism can be defined as a specific student-centered approach to education, in which knowledge is viewed as something that a learner “builds” or “constructs” based on their experiences (Joseph & Juwah, 2012; Paskevicius, 2017). From this perspective, a teacher is tasked with designing the learning experiences that would facilitate the process of knowledge construction (Joseph & Juwah, 2012). CA adopts this perspective: it is learner-centered and constructivist, which determines the types of outcomes and methods that it aligns (Biggs, 2014; Dames, 2013). Also, an important aspect of CA is the difference between “surface” and “deep” learning: the former is concerned with a limited understanding of a studied topic, and the latter involves a more thorough investigation of the relevant content (Larkin & Richardson, 2013; Vanfretti & Farrokhabadi, 2013). This is a summary of the key elements of CA that should be considered when describing it.
History and Relevance to Nursing and Midwifery Education
CA is not a very new idea; supposedly, it was offered in 1949 by Ralph Tyler (Biggs, 2014, p. 6). However, Biggs (2014) notes that traditional teaching is not learner-centered. In particular, the author suggests that traditional curricula are typically centered on the activities of a teacher and the requirements that should be applied to them. This factor also reflects itself in the use of similarly traditional teaching methods (for instance, lectures). Consequently, as Biggs (2014) suggests, the spread of CA was slowed down because it could not exist in an environment that would not support learner-centered approaches.
Joseph and Juwah (2012) also report that the curricula employed in nursing education are often traditional and lack the innovative nature that is required for the field which has to correspond to the changes in the modern world. As a result, even though CA has been employed in education for many years (Ahlin, Klang-Söderkvist, Johansson, Björkholm, & Löfmark, 2017), it is not clear how often it is encountered in nursing education (Joseph & Juwah, 2012). Still, it should be noted that CA can be of use in multiple areas, including nursing and midwifery education.
In this regard, it is appropriate to mention several real-life examples. For instance, Croy (2018) discusses the application of CA to a mental health nursing course. The author reports positive outcomes which are evidenced by the students’ feedback. Similarly, Sunnqvist, Karlsson, Lindell, and Fors (2016) used CA to create a virtual patient simulation program and stated that the approach was well-suited for the task, even though they do not discuss its role in detail. Duff et al. (2017) applied CA to an oral health module in a midwifery program. The latter project was only reviewed by an expert panel, which is why there is not much evidence of the program’s effectiveness; also, the panel’s feedback cannot be attributed to CA exclusively. Still, the examples illustrate the fact that CA applies to nurse and midwifery program development, and the developers state that it can be beneficial for the two fields of education. Thus, it can be concluded that CA is relevant to the topic.
Stakeholders and the Scale of the Topic
The present paper considers the use of CA in ICUNE, which limits the relevant stakeholders to the specialists working in ICU and ICU patients. Indeed, patients may be ones who are most likely to benefit from the actions of well-trained nurses. However, CA would also have a positive impact on ICU nurses’ preparedness and ability to interact with other specialists and engage in teamwork (Croy, 2018), which is particularly important for ICUs. Finally, for nurses, enhanced skills and abilities are also most helpful in their performance, confidence, and career growth. Thus, all the stakeholders of the ICU can be affected by the use of CA in nursing education. The fact that CA can enhance the learning experience is evidenced below.
CA is relatively well-researched and represented in modern literature, but the present paper considers a more specific topic. While there is some research on the use of CA in the field of nursing education, it is not very extensive (Joseph & Juwah, 2012). Furthermore, modern literature does not offer the coverage of the usage of CA in the development of curricula for ICUNE; the present investigation could not find an article that would focus on this topic. Some papers that are devoted to ICUNE mention CA, but they typically do not consider it as one of their primary themes and do not provide any substantial coverage for it or its role in ICUNE (Innes & Calleja, 2018). Thus, the topic is not very frequently explored by modern literature, and the size and scale of the research devoted to it are rather small. Still, the existing studies that cover similar topics can be used to infer some conclusions about the impact of CA on ICUNE.
Impact
There is very little research on the use of CA in ICUNE. Innes and Calleja (2018) mention that CA is important for transition programs, which help new nurses get the necessary knowledge and skills for ICUs. The authors state that CA is essential for the structure of such programs. They also report that the programs, which they reviewed, seemed to have positive outcomes. However, it is not clear if such outcomes should be attributed to CA because the latter is not covered very extensively in the article. Other sources that would do more than mention CA in connection to ICUNE were not found, which is why it is difficult to discuss the impact of CA on this field of training. However, other sources on CA indicate that is can have a positive effect on educational programs, and it appears possible to infer that similar outcomes can be observed for ICUNE as well.
The primary consequence of CA is the improved quality of programs, which stems from their greater standardization, transparency, and coherence (Biggs, 2014; Croy, 2018; Duff et al., 2017). It is the result of the outcomes being aligned with teaching methods and assessment approaches (Croy, 2018; Higgins, Hogg, & Robinson, 2017). Additionally, evidence suggests that CA can improve students’ performance (Larkin & Richardson, 2013). This result is similarly believable because the outcomes-based approaches to education tend to have such effects (Tan, Chong, Subramaniam, & Wong, 2018). Also, learners are shown to change their learning approaches because of the influence of CA; in particular, they adopt “deeper” strategies that enable “deeper” learning (Wang, Su, Cheung, Wong, & Kwong, 2013). This outcome can also be viewed as a positive one. Finally, learners can be more satisfied with CA-based programs, which is shown in the study by Larkin and Richardson (2013). In summary, the benefits of CA are numerous and significant for a model of program development; ICUNE could use them.
Additionally, it should be mentioned that CA is well-suited for nursing education in general and ICUNE in particular. Indeed, nursing education has a very strong focus on practice and skills acquisition (Ahlin et al., 2017), which makes a constructivism-based approach to it very appropriate (Croy, 2018; Leigh et al., 2013). Also, since skills are the desired outcomes, they can be easily integrated into the CA model of teaching (Joseph & Juwah, 2012). CA is also viewed as an appropriate approach for practice-based learning (Wang et al., 2013). Thus, the focus of nursing education on skills and practice makes CA suitable for it.
Furthermore, CA is supportive of collaborative learning, which is particularly important for ICU nurses who need teamwork skills (Croy, 2018). The “deep learning” approach is applicable as well: ICU nurses need a comprehensive and deep understanding of the topics that they study due to the importance of their job for human lives (Berggren et al., 2016; Joseph & Juwah, 2012; Wang et al., 2013). CA is also helpful for nursing education, especially in ICU, because the nurses have prior experiences which they can use to construct knowledge (Tan et al., 2018). Additionally, it can be noted that learner-centredness should be viewed as a beneficial feature for students in any area, which is another positive feature of CA (Higgins et al., 2017). Overall, CA is suggested for the use of nursing education (Stott & Mozer, 2016), and it is recommended for ICUNE as well (Fitzgerald, Wong, Hannon, Tokerud, & Lyons, 2013). All the above-presented factors can be viewed as the benefits of CA that can be helpful in ICUNE.
At the same time, CA has some notable challenges. First, even though CA can be used at every educational level, which is one of its advantages, Biggs (2014) highlights the fact that it is more difficult to implement it at a grander scale because CA requires an institutional climate that supports learner-centered education. Additionally, the author concedes that other elements of CA education can conflict with the specific rules of an institution, including, for instance, particular approaches to evaluation or course content structures. Overall, the traditional features that may be present in an institution can undermine the use of CA in individual and especially institution-wide practice.
Furthermore, if CA is being introduced in new settings, resistance to change can be a problem (Biggs, 2014). In general, the implementation of CA needs to include more than surface compliance; it requires the support of the educators involved in the process (Larkin & Richardson, 2013). A major challenge in this regard is that CA needs a notable amount of work, especially for the achievement of the best quality of teaching. The process of the development of the CA curriculum can be particularly time- and resource-consuming, especially when a large-scale implementation is concerned (Biggs, 2014; Croy, 2018). This issue can be connected to another problem: the process of achieving alignment can be problematic and difficult, especially for an unprepared person (Trigwell & Prosser, 2013). In general, it can be suggested that CA-based programs are not easy to develop and implement, which is its main challenge.
It should also be noted that CA leaves room for variations, which can be a positive feature because it enables educators to search for the approaches that would fit their learners the best. However, it is also a problem since the quality of the chosen elements might differ because of this variation, which results in the possibility of developing well-aligned but ineffective programs (Trigwell & Prosser, 2013). As a result, it can be suggested that while alignment may be crucial for a program’s quality, the choice and management of the elements are similarly important, which further complicates the challenge of program development. Thus, the primary limitation of CA is that it does not guarantee the positive outcomes of programs; rather, it is one of the tools that an educator should employ to improve the quality of their work. In summary, CA has some challenges and limitations, which can be interrelated with its benefits, but CA’s positive features are particularly promising, which makes the approach noteworthy.
Solutions
The solutions to the above-presented issues are likely to target different audiences, but in the majority of cases, the cooperation of stakeholders will be required. For the implementation problem, the first dimension to be considered is the difficulty of CA use. In this regard, there are some common approaches to CA which can facilitate its application. An example is a one-verb method, in which the same verb is used in the phrasing of an outcome and the methods associated with it to ensure their alignment. Biggs (2014) views this strategy as integral to CA, and while it does not completely resolve the problem of CA’s complexity, it can facilitate the process of CA-based education program development. Similarly, the employment of specific steps that have been developed for CA can guide one’s practice of program development (Berggren et al., 2016; Croy, 2018). Based on this information, it can be suggested that the primary strategy for the facilitation of CA use is the investigation of the existing literature on the topic and its study by the educators to get ready to employ CA effectively.
This approach would also help to manage CA’s limitations. Since the methods of a well-aligned program also need to be high-quality, the integration of various modern evidence-based approaches to education may be helpful, and educators need to be aware of them. Overall, the preparation of educators to employ CA is important; it is necessary to ensure that they have a good perspective on all the relevant elements (Turjamaa et al., 2018). By enhancing their knowledge of teaching methods, especially those compatible with constructivism, nurse educators will be able to improve the quality of their work, and this strategy is perfectly applicable to the ICU context.
Indeed, the first solution is the improvement of educators’ knowledge, which is an activity that should be performed by ICU nurse educators themselves. However, other stakeholders can also assist them in this process. For instance, the managers and administrators can provide the resources necessary for this endeavor and otherwise encourage educators’ professional development. Thus, the cooperation of stakeholders in this regard would be particularly promising.
On the other hand, the strategies for removing the CA-conflicting elements from an institution’s system and the reduction of resistance to change are mostly meant for the administration, but educators can provide important advice on the matter. Regarding the issues that can hinder CA, they can be numerous, but examples might include the time allocated for ICUNE or the specific approaches to measuring ICUNE progress (Biggs, 2014). An educator would be particularly good at detecting such problems. The matter of the time which is consumed by CA can also fit into this category: ICU educators need to detail the data on the requirements of the process, and managers need to provide the relevant resources. As for the resistance to change, both educators and other stakeholders (including the nurses in training) can assist by providing the leadership which is necessary to eliminate the issue. Thus, both key strategies can be employed in ICU settings.
The anticipated drawback of the mentioned solutions is that they are going to consume resources (funds, time, and effort). However, their main limitation is that they can only be fully effective if the collaboration of stakeholders is present. While individual educators can work to improve their knowledge, they might be held back by the lack of institutional support. While managers can allocate extra resources for educators’ CA efforts, they are unlikely to be able to do that effectively without any input from the educators. Thus, the challenges that are connected to CA can be resolved only through active collaboration, which should be aimed at the preparation of educators for their work with CA and the development of an institutional support system for CA. As a result, ICU nurse educators need to ensure the engagement of the relevant stakeholders. Given the benefits of CA, dedicating the efforts to resolving the mentioned issues is worthwhile.
Conclusions
CA is an approach to educational program development that aligns teaching and assessment methods, as well as other components of teaching, with learning outcomes. The concept has been present for over 60 years, but its use in ICUNE is not explored. Still, it can be assumed that CA fits ICUNE because it is practice- and learner-oriented; it is also good for collaborative and deep learning. CA is evidenced to have beneficial outcomes, including improved performance and learner satisfaction; it enhances the transparency and coherence of educational programs, which is why it should be applied to ICUNE. Admittedly, CA is associated with notable challenges because it is resource-consuming and difficult to implement; also, CA cannot guarantee the high quality of resulting programs. However, the mentioned issues can be resolved through the collaboration of stakeholders with the help of the strategies aimed at improving educators’ preparedness to use CA and institutions’ ability to support it.
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