Introduction
The present paper is devoted to the continued development of a training course for 22 nurses of the Emergency Unit of King Saud General Hospital who have varied levels of expertise and experience (from two to nine years of experience in the settings). The course is going to be considered from the conversational framework (CF) of learning that describes complex processes of interactions between a learner, his or her peers, and the teacher.
The course is going to be designed to address the nurses’ educational needs according to the needs assessment survey that was carried out before this work. The survey also served to discover the specifics of the learners’ group and their preferred instructional methods. The paper will describe CF, regard it from the points of view of three learning theories (constructivism, humanism, cognitivism) and apply CF to the course, in particular, to the use of multimedia in it.
Discussion
Conversational Framework
Conversation or communication is central to CF, including the interaction between the teacher and the student and that between the students (Salyers, Carter, Cairns, & Durrer, 2014; Stephens & Hennefer, 2013). The model is complex, and it includes numerous channels and forms of interaction between all the participants; the learner is “placed” between the teacher and the students and engaged in collaborative and cooperative learning, which involves the development of “cognitive and conceptual knowledge (i.e. ‘‘knowing why’’) as well as procedural and reflective knowledge (i.e. ‘‘knowing how’’) at a group level” that occurs with the help of the teacher’s work as a facilitator (Atif, 2013, p. 419).
In the process of interactions, the exchange of concepts and ideas occurs that is then adapted to practice, “observable student activity” (Knewstubb, 2014, p. 528). The practical tasks are carried out together with peers and presented to the teacher to receive feedback and allow the reflection for all the members involved (including the teacher who perfects the task); the processes are cyclic and iterative, and the learning can occur at any moment (Knewstubb, 2014; Selesho, 2012). The communication does not have to be face-to-face; various mediators (written works, online forums) enable CF as well (Knewstubb, 2014, p. 529). As a result, such an approach is useful for modern forms of online education (Walji, Deacon, Small, & Czerniewicz, 2016).
Constructivism
Constructivism can be regarded as one of the learning theories that is opposed to behaviorism and related instruction with their central role of the teacher as a controller of the learning environment (Duane & Satre, 2014; Kay & Kibble, 2016). CF, on the other hand, contains instructional elements (Atif, 2013), but it is not limited to them, which is why it can be connected to constructivism as well. Constructivism focuses on the different experiences with social and cultural aspects of encounters that the learners use to construct knowledge with the help of language (Duane & Satre, 2014; Hoy, Davis, & Anderman, 2013). As a result, social constructivism was developed with an emphasis on the social environment of the learner and individual experiences (Thomas, Menon, Boruff, Rodriguez, & Ahmed, 2014). Naturally, the approach is learner-centered, which is CF-compatible.
Duane and Satre (2014) demonstrate that the constructivist environment is more suited for knowledge generation than the instructive one as it invites conversation between domains and within them, which also illustrates the apparent connection of CF to constructivism. Apart from that, Duane and Satre (2014) mention that constructivism learning theory has been proven to be beneficial to nursing students in enhancing their cooperation abilities. Thus, according to the authors, the theory provides the students with the means of developing the “interpersonal form of critical thinking” that is required of full-fledged nurses (Duane & Satre, 2014, p. 32), which is of importance for the current study.
Cognitivism
Cognitivism appeared as a reaction to behaviourism, and it focuses on the way the human brain works with knowledge (Aliakbari, Parvin, Heidari, & Haghani, 2015; Hoy et al., 2013). The model was the first to regard learners as active agents of studying, and it was the first learner-centred approach that acknowledged the fact that every learner is unique from pre-existing qualities (Hoy et al., 2013; Kay & Kibble, 2016). Therefore, CF is connected to cognitivism through its attitude to the learner as the centre of the learning process that is active in knowledge acquisition. Also, reflection is of primary importance for cognitivism (Burke & Mancuso, 2012), which is also featured by CF.
Humanism
Humanism is a particularly learner-centred approach: it places emphasis on the learner’s experience, which is not new, but it also considers the importance of feelings; it regards learning as a means of self-actualization and development and insists that the development should be measured by the individual’s standards (Aliakbari et al., 2015; Melincavage, 2013).
As a result, the legacy of the humanistic approach is seen in CF’s attention to the learner and his or her development. Similarly, experiential learning and self-reflection are of supreme importance for the humanistic approach, which also shows CF’s connection to it; humanism also suggests that all people want to learn, and the teacher is only supposed to facilitate the process, not direct it since no external observer is capable of fully understanding another person (Aliakbari et al., 2015, pp. 38-39).
Application: Curriculum Development
The value of CF
Duane and Satre (2014) demonstrate that nursing practice cannot be effective without collaboration, which holds implications for nursing education. Therefore, the employment of CF in the current project is justified by the learning environment and the development of the “interpersonal form of critical thinking” in the nurses (Duane & Satre, 2014, p. p. 32). Atif (2013) insists that CF results in more extensive development of knowledge due to the active ideas exchange, even though the author does comment on the effectiveness-enhancing methods like classroom organization and technology use that would enable such an improvement.
Therefore, the use of CF in the process is also justified by the expected improved outcomes; also, the fact that the nurses have a different experience (which was identified during the survey) implies that those with greater expertise can improve the outcomes of less experienced ones. It is mainly true since the course is aimed at refreshing and solidifying the knowledge that the nurses have. Finally, a benefit of CF consists of emotional support that peers provide to each other (Walji., et al. 2016, p. 11). The team-building effect would be very useful for nurses who work together.
Examples of multimedia use
Atif (2013) highlights the positive effect that technology has on CF. Indeed, the use of modern technologies in learning and teaching environments is a progressive approach that allows enhancing learning experiences (Camarero, Rodríguez, & San José, 2012). In particular, computer development has led to the creation of multimedia tools that involve “computer-based systems that use associative linkages to allow users to navigate and retrieve information stored in a combination of text, sounds, graphics, video, and other media” (Sowan, 2014, p. 2).
The use of multimedia in nursing education remains underresearched (Forbes et al., 2016; Nowak, Speakman, & Sayers, 2016), but it is extensively used in the area (Sowan, 2014), and the evidence does indicate that successful outcomes are a possibility (Atif, 2013; Petty, 2013). Multimedia use is known to enhance learning processes (especially memorizing) and motivation of the students (Ljubojevic, Vaskovic, Stankovic, & Vaskovic, 2014; Petty, 2013).
The preliminary educational plan that was developed using the survey’s results on nurses’ preferences presupposes the use of multimedia (presentations and videos). For example, the PowerPoint presentation by Miller (2013) from the Metropolitan Community College offers an overview of IV Therapy. It uses text and illustrations and presupposes the use of speech; it also contains one slide meant for questions and feedback. It is a usable example that applies several components of CF: it can be regarded as the teacher-provided concepts element that also invites questions (presupposing answers). To make it more aligned with CF, it is possible to modify it by including practical group tasks with subsequent feedback and revisions, or regard it as a first step in the lesson and complement it with other activities. In my lesson, I would consider customizing the presentation to break up the chunks of information into smaller pieces that would be studied and memorized better through group tasks.
It is noteworthy that PowerPoint presentations are preferred by 100% of nurses who have completed the survey, and the cases of their effective use in nursing education have been evidenced (Nowak et al., 2016).
Apart from presentations, videos are also of use within CF. Videos were chosen by over 80% of the survey participants, which made it the second most popular instructional technique in the hospital. Here is an example of a “how-to” video on IV pumps developed y EmpoweRN (2014). Where an oral presentation presupposed face-to-face interaction, a video can be regarded as a sound-and-graphics mediator (when the teacher is considered). However, it is noteworthy that videos per se are not typically regarded as a separate means of education; rather, they are the basis of more interactive activities, including group discussions (Buckley, Kavanagh, Traynor, & Neary, 2014), which makes them an appropriate starting point for a CF lesson. When used appropriately (not separately), videos are believed to be very instructional and are widely used in nursing for the sake of viewing and discussing role models (Sowan, 2014).
Conclusion
CF is a framework that attempts to describe the complex set of interactions between the people involved in the learning process where the learner becomes the center while the teacher and the peers are also active participants. It can be concluded that CF has been based on the developments in the learning theory that have been moving away from instructive and towards learning-centeredness (cognitivism, constructivism, humanism). However, unlike the humanist approach, the teacher-observer-facilitator is not detached from the process; rather, he or she is a full-fledged member of CF that has his or her functions in the development of the learner and is also subject to reflection. These principles are capable of informing the development of the training course for the Emergency Unit of King Saud General Hospital nurses due to fitting the settings, type of the course, and characteristics of the learners. In particular, this paper demonstrates how the multimedia-assisted activities that have been placed in the course plan (based on the nurses’ preferences) can be used to build CF-compatible lessons and activities.
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