AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
PROGRAM DESIGN FOR ADULT LEARNERS Audrey C. Martins, PhD, RN Associate Professor, School ofNursing, Curtin University of Technology, Perth, Western Australia The voice of adult learners is often overlooked in the design ofprograms that are specifically constructed to meet their learning needs. This article portrays the design of a midwifery re-registration program that commenced with a survey ofnon-practising midwives. The organisation of the course, together with the processes involved in curriculum building are explained. Theadult learner,particularly in a situation where previous knowledge, skills and experience are vital inputs to the design of programs, have been highlighted.
Program designed for adult learners 1\\'0 main factors influenced the development of a
re-registration midwifery program based on Knowles (1975) concepts of adult learning. The program was designed and implemented at Stjohn ofGod Hospital in Western Australia. First, the voice of adult learner that was encountered during a survey to establish whether a need existed for a second re-registration program in the State(one was already in operation at a public hospital in Perth) was considered. Expressed views conveyed the.drawbacks of traditional re-entry programs. These included predetermined fixed learning experiences that allowed minimal consideration ofadult learner differences. Second, the requirement ofattendance at the school for the entire program was considered unnecessary. Instead, an alternative of some elements conducted on an external or distance education mode was expressed. The mandatory attendance requirement was seen to particularly disadvantage nurses in rural communities, who had the additional expense of travel to the metropolitan area, as well as the payment of board and lodging for the duration of the course. These two factors coupled with sufficient demand for a second reregistration midwifery course became the catalyst for a program designed for adult ICarners.
establishingan advisory committee about 18months before the course was offered. The advisory committee consisted of a nursing curriculum consultant, an obstetrician, a neonatal paediatrician and three nurse educators from the Stjohn of God Midwifery School ofNursing. Practitioners from various clinical areas like labour ward, antenatal and home births, together with other allied health professionals, were co-opted onto the committee as needed. The advisory committee met weekly during the early stages of course planning, followed later by regular but less frequent meetings. In the beginning, questions were explored in relation to employment, the need and choice of clinical experience in the course, organisation of course content, and whether the course should emphasise new procedures, problems and treatments in midwifery practice, or should course content be a review and update of knowledge and skillsto safely practice as a midwife. In allthe deliberation, a converging focus centred on clinical competence and related adult learner issues emerged. These were:
Course development Devising a curriculum is a very special province of the teaching faculty if they are to develop a sense of curriculum ownership (Scales1985: 2). Hence, planning, conferring and curriculum writing began by PAGE24
ACMIJOURNAL
• What teaching strategies utilising previous knowledge and skills of the re-entering learner best develops clinical problem-solvlng skills. • How to structure content to update reproductive biology and related sciences apart from didactic teaching/learning. • How to correlate and find a balance between classroom and clinical practice, to facilitate confidence of the adult learner returning to practice. • What influences in the nursing laboratory and clinical practice (e.g.number of hours, selection of settings and preceptors and learner/preceptor ratios)are associated with the levelof performance for the re-entry midwife. • How to evaluate learning outcomes in order to recommend re-registration as a midwife to the Nurses Board of Western Australia. SEPTEMBER 1992
AUSTRALIAN COLLEGE OF MIDWlVES INCORPORATED
One way to develop a course based on these questions was to construct a conceptual framework to guide the process, and promote what Ausubel (1968) considers as 'meaningful learning'.
Conceptual framework Aconceptual framework embodying a paradigm of the learner, the Outcomes oflearningand the process of learning allowed a conceptualisation of the philosophy underpinning the course as a whole (White 1983: 28) . It helped to guide the curriculum implicitly by that which was deemed to be of value in the educational endeavour. Curriculum conceptual framework ADULT LEARNER
LEARNER'S OUTCOME
• Experience • Knowledge
• Desired behaviours needed for safe midwifery practice
• Skills
• Attitude LEARNING PROCESS
• Participatory adult learning strategies • Facilitating learning Outcomes • Reflective practicum
Philosophy The philosophy of the Stjohn of God teaching staff was that: • the non-practising midwife would naturally have anxieties about knowledge and skills needed for modern midwifery practice. • returning midwives are adult learners and as such require self-directed teaching strategies compatible with life's experiences, problem-solving skills and ability for self-directed study.
Course structure Based on these beliefs, a course of about 80 hours school based learning integrated with 80 hours of practicurn, was designed. The aim was to review, reawaken and build upon existing knowledge, skills and attitudes, to maintain motivation and to foster the joy oflearning. The practicum ofthe course was developed on what Schon (1987) calls 'reflective practice' which aimed at capitalising on the artistry ofadult learners. Artistry was seen in terms of the act of problem framing, planning, implementation and SEPTEMBER 1992
improvisation needed to assist learners to competence in the indeterminate zone of practice. The ultimate aim of the re-registration course was to prepare the returning midwife to be competent to practice midwifery, The process of performance examination, therefore, became an important consideration of program design. Carefully constructed and consistently administered examinations, as advocated by Lenburg (1979) set the standards for performance evaluation and served as a guide to learning those competencies expected by the Nurses Board of Western Australia (1990) . Foundations for the course consisted ofan external package of Reproductive Biology and Related Sciences. It was intended that learners would work at their own pace and be admitted to the course when they were ready and had completed the accompanying work assessment of the study package. In addition to Foundation Studies and Practicurn, two other areas of the course, Nursing Studies and Nursing Skills were developed (see curriculum model). The former consisted of the essential cognitive learning related to the theory of midwifery practice. For this unit, students with the assistance of the midwifery teachers would develop a syllabus based on the learning needs of that particular intake of students. The content of Nursing Studies, therefore, could vary from group to group. The emphasis was on using a flexible approach to meet learning needs. The process of teaching suggested a variety of teaching models that could be best suited for a group of adult learners aoyce and Weil 1987). The returning midwife often lacks confidence in nursing skills that are new as well as those that were once well developed. To meet this learning need, well equipped instruction manuals, charts, skeletal and other models and audiovisual material on the various procedures was made available for students to redevelop their psychomotor skills in a controlled, non-threatening environment. The competencies of the Nurses Board ofWestern Australia for Midwifery practice was a reminder of the mastery of learning required for registration as a midwife. Assistance from teachers was available when needed and performance validated when requested as adult learner responsibility was inherent in the course de sign . ACMI JO URNAL
PAGE2';
AUSTRALIAN COLLEGEOF MIDWIVES INCORPORATED
The following curriculum model reflects the various components of the re-registration midwifery program:
CURRICULUM MODEL UNIT
FOUNDATION STUDIES COURSE OF STUDY enabling CLINICAL PRACTICE
re-registration as a midwife, as required by the Nurses Board ofW.A.
MIDWIFERY STUDIES
References Ausubel, D.P. Education Psychology: A Cognitive View. New York. Holt , Rinehart & Winston, 1968. Joyce, B. and Wil, M. Models of Teaching (3rd Edn) . New Jersey. Prentice Hall, 1987. Knowles, M. Self-directed Learning: A Guide for Learners and Teachers. New York. Association Press , 1975. Lenberg, C.B. Tbe Clinical Performance Examination. New York. Prentice Hall, 1979 , p35-64. Scales, F.S. Nursing Curriculum: Development, Structure, Function. Norwalk. Appleton-Century Crofts, 1985, p2. Schon, D.A. Educating tbe Reflective Practitioner: 'Ibtoard a New Design for Teaching and Learning in tbe Professions. San Francisco. jossey-Bass, 1987. Standards of Midwifery Practice. Nurses Board of Western Australia, 1990 . White, M.B. (ed) Curriculum Development from a Nursing Model. New York. Springer Publishing Co., 1983, p28.
MIDWIFERY SKILLS
Access to the course • Midwives who had not practised for five years or more and who wished to be eligible to re-register with the Nurses Board of Western Australia. • Midwives from other parts of the world who did not meet the requirements of the Nurses Board of Western Australia and who wished to register as such.
Conclusion The guiding principle throughout course development was that learning is facilitatedin an atmosphere in which people are encouraged to trust in themselves as well as in external sources. The aim was to assist the learner to become less dependent upon authority so that they feel that they are a valuable resource for learning. It was important that the course offered would make the returning midwives feel that they had something to bring to the learning Situation, rather than viewing learning as the acquisition of facts and knowledge from some external agent for use some time in the future. The curriculum builders strongly believed that adults learn best when they begin to see themselves as the wellsprings of ideas and when learner abilities and limitations are considered in a supportive milieu that increases their self-esteem. PAGE 26
ACMIJOURNAL
Nurses USA • Generous Packages (Return Airfares, Visas, Accommodation, etc.)
California Hospital needs Midwifery (L & D)Nurses, who: • Grad in Australia after 1987 (no further exams will be necessary), or • arelicensed in USA or Canada. Call for an imervie« now
(02) 231 5455 (B. H.)
or fax your C~. to (02) 234 2128
YALE HEALTH CARE DIVISION Level 26, State BankCentre, 52 Martin Place, Sydney NSW 2000
SEPTEMBER 1992
PROGRAM DESIGN FOR ADULT LEARNERS Audrey C. Martins, PhD, RN Associate Professor, School ofNursing, Curtin University of Technology, Perth, Western Australia The voice of adult learners is often overlooked in the design ofprograms that are specifically constructed to meet their learning needs. This article portrays the design of a midwifery re-registration program that commenced with a survey ofnon-practising midwives. The organisation of the course, together with the processes involved in curriculum building are explained. Theadult learner,particularly in a situation where previous knowledge, skills and experience are vital inputs to the design of programs, have been highlighted.
Program designed for adult learners 1\\'0 main factors influenced the development of a
re-registration midwifery program based on Knowles (1975) concepts of adult learning. The program was designed and implemented at Stjohn ofGod Hospital in Western Australia. First, the voice of adult learner that was encountered during a survey to establish whether a need existed for a second re-registration program in the State(one was already in operation at a public hospital in Perth) was considered. Expressed views conveyed the.drawbacks of traditional re-entry programs. These included predetermined fixed learning experiences that allowed minimal consideration ofadult learner differences. Second, the requirement ofattendance at the school for the entire program was considered unnecessary. Instead, an alternative of some elements conducted on an external or distance education mode was expressed. The mandatory attendance requirement was seen to particularly disadvantage nurses in rural communities, who had the additional expense of travel to the metropolitan area, as well as the payment of board and lodging for the duration of the course. These two factors coupled with sufficient demand for a second reregistration midwifery course became the catalyst for a program designed for adult ICarners.
establishingan advisory committee about 18months before the course was offered. The advisory committee consisted of a nursing curriculum consultant, an obstetrician, a neonatal paediatrician and three nurse educators from the Stjohn of God Midwifery School ofNursing. Practitioners from various clinical areas like labour ward, antenatal and home births, together with other allied health professionals, were co-opted onto the committee as needed. The advisory committee met weekly during the early stages of course planning, followed later by regular but less frequent meetings. In the beginning, questions were explored in relation to employment, the need and choice of clinical experience in the course, organisation of course content, and whether the course should emphasise new procedures, problems and treatments in midwifery practice, or should course content be a review and update of knowledge and skillsto safely practice as a midwife. In allthe deliberation, a converging focus centred on clinical competence and related adult learner issues emerged. These were:
Course development Devising a curriculum is a very special province of the teaching faculty if they are to develop a sense of curriculum ownership (Scales1985: 2). Hence, planning, conferring and curriculum writing began by PAGE24
ACMIJOURNAL
• What teaching strategies utilising previous knowledge and skills of the re-entering learner best develops clinical problem-solvlng skills. • How to structure content to update reproductive biology and related sciences apart from didactic teaching/learning. • How to correlate and find a balance between classroom and clinical practice, to facilitate confidence of the adult learner returning to practice. • What influences in the nursing laboratory and clinical practice (e.g.number of hours, selection of settings and preceptors and learner/preceptor ratios)are associated with the levelof performance for the re-entry midwife. • How to evaluate learning outcomes in order to recommend re-registration as a midwife to the Nurses Board of Western Australia. SEPTEMBER 1992
AUSTRALIAN COLLEGE OF MIDWlVES INCORPORATED
One way to develop a course based on these questions was to construct a conceptual framework to guide the process, and promote what Ausubel (1968) considers as 'meaningful learning'.
Conceptual framework Aconceptual framework embodying a paradigm of the learner, the Outcomes oflearningand the process of learning allowed a conceptualisation of the philosophy underpinning the course as a whole (White 1983: 28) . It helped to guide the curriculum implicitly by that which was deemed to be of value in the educational endeavour. Curriculum conceptual framework ADULT LEARNER
LEARNER'S OUTCOME
• Experience • Knowledge
• Desired behaviours needed for safe midwifery practice
• Skills
• Attitude LEARNING PROCESS
• Participatory adult learning strategies • Facilitating learning Outcomes • Reflective practicum
Philosophy The philosophy of the Stjohn of God teaching staff was that: • the non-practising midwife would naturally have anxieties about knowledge and skills needed for modern midwifery practice. • returning midwives are adult learners and as such require self-directed teaching strategies compatible with life's experiences, problem-solving skills and ability for self-directed study.
Course structure Based on these beliefs, a course of about 80 hours school based learning integrated with 80 hours of practicurn, was designed. The aim was to review, reawaken and build upon existing knowledge, skills and attitudes, to maintain motivation and to foster the joy oflearning. The practicum ofthe course was developed on what Schon (1987) calls 'reflective practice' which aimed at capitalising on the artistry ofadult learners. Artistry was seen in terms of the act of problem framing, planning, implementation and SEPTEMBER 1992
improvisation needed to assist learners to competence in the indeterminate zone of practice. The ultimate aim of the re-registration course was to prepare the returning midwife to be competent to practice midwifery, The process of performance examination, therefore, became an important consideration of program design. Carefully constructed and consistently administered examinations, as advocated by Lenburg (1979) set the standards for performance evaluation and served as a guide to learning those competencies expected by the Nurses Board of Western Australia (1990) . Foundations for the course consisted ofan external package of Reproductive Biology and Related Sciences. It was intended that learners would work at their own pace and be admitted to the course when they were ready and had completed the accompanying work assessment of the study package. In addition to Foundation Studies and Practicurn, two other areas of the course, Nursing Studies and Nursing Skills were developed (see curriculum model). The former consisted of the essential cognitive learning related to the theory of midwifery practice. For this unit, students with the assistance of the midwifery teachers would develop a syllabus based on the learning needs of that particular intake of students. The content of Nursing Studies, therefore, could vary from group to group. The emphasis was on using a flexible approach to meet learning needs. The process of teaching suggested a variety of teaching models that could be best suited for a group of adult learners aoyce and Weil 1987). The returning midwife often lacks confidence in nursing skills that are new as well as those that were once well developed. To meet this learning need, well equipped instruction manuals, charts, skeletal and other models and audiovisual material on the various procedures was made available for students to redevelop their psychomotor skills in a controlled, non-threatening environment. The competencies of the Nurses Board ofWestern Australia for Midwifery practice was a reminder of the mastery of learning required for registration as a midwife. Assistance from teachers was available when needed and performance validated when requested as adult learner responsibility was inherent in the course de sign . ACMI JO URNAL
PAGE2';
AUSTRALIAN COLLEGEOF MIDWIVES INCORPORATED
The following curriculum model reflects the various components of the re-registration midwifery program:
CURRICULUM MODEL UNIT
FOUNDATION STUDIES COURSE OF STUDY enabling CLINICAL PRACTICE
re-registration as a midwife, as required by the Nurses Board ofW.A.
MIDWIFERY STUDIES
References Ausubel, D.P. Education Psychology: A Cognitive View. New York. Holt , Rinehart & Winston, 1968. Joyce, B. and Wil, M. Models of Teaching (3rd Edn) . New Jersey. Prentice Hall, 1987. Knowles, M. Self-directed Learning: A Guide for Learners and Teachers. New York. Association Press , 1975. Lenberg, C.B. Tbe Clinical Performance Examination. New York. Prentice Hall, 1979 , p35-64. Scales, F.S. Nursing Curriculum: Development, Structure, Function. Norwalk. Appleton-Century Crofts, 1985, p2. Schon, D.A. Educating tbe Reflective Practitioner: 'Ibtoard a New Design for Teaching and Learning in tbe Professions. San Francisco. jossey-Bass, 1987. Standards of Midwifery Practice. Nurses Board of Western Australia, 1990 . White, M.B. (ed) Curriculum Development from a Nursing Model. New York. Springer Publishing Co., 1983, p28.
MIDWIFERY SKILLS
Access to the course • Midwives who had not practised for five years or more and who wished to be eligible to re-register with the Nurses Board of Western Australia. • Midwives from other parts of the world who did not meet the requirements of the Nurses Board of Western Australia and who wished to register as such.
Conclusion The guiding principle throughout course development was that learning is facilitatedin an atmosphere in which people are encouraged to trust in themselves as well as in external sources. The aim was to assist the learner to become less dependent upon authority so that they feel that they are a valuable resource for learning. It was important that the course offered would make the returning midwives feel that they had something to bring to the learning Situation, rather than viewing learning as the acquisition of facts and knowledge from some external agent for use some time in the future. The curriculum builders strongly believed that adults learn best when they begin to see themselves as the wellsprings of ideas and when learner abilities and limitations are considered in a supportive milieu that increases their self-esteem. PAGE 26
ACMIJOURNAL
Nurses USA • Generous Packages (Return Airfares, Visas, Accommodation, etc.)
California Hospital needs Midwifery (L & D)Nurses, who: • Grad in Australia after 1987 (no further exams will be necessary), or • arelicensed in USA or Canada. Call for an imervie« now
(02) 231 5455 (B. H.)
or fax your C~. to (02) 234 2128
YALE HEALTH CARE DIVISION Level 26, State BankCentre, 52 Martin Place, Sydney NSW 2000
SEPTEMBER 1992
