Nurse Education Today, Volume 25, Issue 7, Pages 502-508

Approaches to teaching: current opinions and related research

Published by Elsevier

Maggi Banning , B.Sc. (Hons), M.Sc. PGDE, EdD, SRN, SCM.

Approaches to Teaching

The changing face of teaching has moved away from didacticism to learning facilitation

and with this is the need for teachers to play different roles and use new techniques

(Griffin, 2002, Jarvis, 2002). Three main styles of teaching are propounded; didactic,

socratic and facilitative. The diversity of styles provides a degree of flexibility that allows

one to alter the task of teaching whether it is teacher-centred or student-centred. Jarvis

(2002) views teaching as both an art and a science. In doing so, one can combine the

authoritarian didacticism approach with the democratic facilitator’s approach with no

limit on the combinations.

The lecture is “probably the most frequently employed teaching technique despite all the

criticisms that have been levelled against it” (Jarvis, 1983 p 117). It is “an economical

means of transmitting factual information to a large audience, although there is no

guarantee that effective learning will result” (Walkin, 2000, p 55). The didactic approach

to teaching primarily involves lecturing and is essentially teacher-centred (Entwistle,

1997). Fry, Ketteridge & Marshall (2003) reminds us that although the lecture remains a

major method of teaching in adult and continuing education, and is still recognised “as a

1
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

useful teaching tool” as it can provide a framework of ideas and theories but it needs to

be complemented by interaction and adult-oriented strategies due to attention span and

lack of participation.

Didacticism raises numerous constraints which involve rote learning, learning by note

taking, and potential boredom as the approach limits student participation and reflection.

Many traditional lecturers continue to use the lecture as a means of teaching, especially

when the subject is new to the majority of students or if the students are teacher

dependent, anxious or disorganised as learners (Walkin, 2000).

Radical pedagogies have challenged conventional classroom practice where the student is

the recipient of new knowledge and the teacher is the knower. Teaching is “no longer

seen as imparting knowledge and doing things to the student, but is redefined as

facilitation of self-directed learning” (Tight, 1996, p 26). In an attempt to alter this

position, the teacher can use problem-solving techniques and vicarious learning strategies

to encourage students to articulate and theorize what they know already in relation to the

meaning of their experiences and their interpretation (Preece & Griffin, 2002). Sharing of

experiences allows students to critically think and undertake structured reflection on how

the events may influence their personal circumstances. This facilitative approach to

teaching teases out previous learning and helps students ‘make sense’ of experiences in

relation to real world events (Gregory, 2002). Experiential learning reflects the ontology

of the learner and can impact on both propositional and process knowledge forms

2
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

(Knowles et al., 1998) and in doing so, make a positive contribution to the students’

learning, motivation and their ability to become self-directive.

In order to facilitate learning, teachers must be competent, possess self-esteem, hold

authority within the classroom, show compassion, respect for individuals and be flexible

in the range and style of teaching methods. They can be challenged and should be able to

form relationships between themselves and the students (Freeth & Parker, 2003). To be

effective facilitators, teachers need to be accomplished in the educational attributes they

may want students to acquire.

The “qualities that exist in the personal relationship between the facilitator and the

learner” are important (Rogers, 1989, p 121). This emphasis on the facilitation of learning

correlates with the humanistic approach to learning and represents a shift from didactic

exposition to one of empowering the student to learn theory and skills. The facilitator’s

role is one that encourages students to engage in intellectual analysis, critically think,

problem solve, describe experiences (Haith-Cooper, 2003, Gregory, 2002) and challenge

learning (Haith-Cooper, 2000). Challenge is an aspect of learning facilitation that is

commensurate with transformational learning (Entwistle, 1997).

Different styles of facilitation are established (Gilmartin, 2001). Didactic-experiential is

viewed as the least effective facilitative method, as lecturers can become defensive whilst

engaging in group work and fail to address high-level challenges from students

(Gilmartin, 2001). Poor facilitation of learning can have a detrimental effect on student

3
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

morale, and induce reduced confidence and motivation to achieve (Banning, 2004).

Lecturers who fall into this category are essentially ill-equipped to undertake learning

facilitation, as they may not appreciate the professional constraints that influence the

learning environment (Haith-Cooper, 2000 & 2003). In contrast critical pedagogy is the

most facilitative style of facilitation, as it hands over the responsibility for learning to the

student as they debate cognitive and intuitive perceptions (Gilmartin, 2001). These

features are commensurate with the development of academic awareness and clinical

reasoning skills in students and concur with the characteristics of student empowerment

(Brookfield, 1996).

Although the facilitation of learning caters for the adult learner (Knowles, 1990), to

succeed in this approach, students require the theoretical ingredients for effective and

comprehensive learning and the acquisition of skills in clinical reasoning. To achieve this

students require a compilation of learning materials and academic support; both elements

are crucial, especially when the discipline is unfamiliar. Failure to provide these elements

will result in surface learning which is based on the memorization of poorly

comprehended theory (Marton & Säljö, 1997, Banning, 2004).

The socratic method of teaching also emphasises student-centredness and strongly

opposes didacticism. Brownhill (2002) illustrates how teachers can use either

authoritarian or non-authoritarian socratic teaching positions to enhance students to learn

independently and become critical thinkers. Teachers provide the initial theoretical

positions and introduce the associated inconsistencies and attributes in an attempt to raise

4
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

awareness in students, initiate reflection and ponder on the key concepts. Both autocratic

and non-autocratic teaching approaches equally enhance the ability of students to

conceptualise and reflect on positions.

Teaching scientific disciplines

For more than a decade, the difficulty of teaching scientific theory to nurses has been

debated. Key concerns focus on the variance in student comprehension, the

disproportionate allocation of scientific and non-scientific subjects within curricula and

the continual use of ineffective teaching strategies (McKee, 2002, Davies et al., 2000).

The theory practice divide appears wider due to inappropriate clinical application

(Tanner, 2000). This deficit contributes to the inadequate scientific preparation of nurses

and a workforce that are unable to articulate the relevance of biological knowledge to

clinical situations, or communicate scientific information to patients and their relatives

(Clancy et al., 2000, Latter et al., 2000). Theoretical deficits in pharmacology are also

apparent and require theoretical models to encourage improved teaching by nurse

educators (Banning, 2003). My study explored the participants’ experience of teaching on

an independent nurse prescribing course, findings indicated that knowledge transmission

was the predominant teaching strategy used with little emphasis on the application of

theory to practice. Self-directed study strategies were used as a back-up strategy even

though students were provided with negligible academic support and guidance. In this

situation, academic engagement of students was limited. Lecturers on this course needed

to incorporate process oriented teaching strategies such as problem solving, case analysis,

5
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

think aloud seminar and simulation to facilitate students learning of the scientific

elements of prescribing (Banning, 2004).

Teaching practical skills

For learners undertaking vocational training, the skills to be taught should “resemble the

real task, even if some of the distractions and complications of the real world have to be

stripped away to lay bare the skeleton of the skill” (Rogers, 1989, p 49). When the skills

to perform a specific job are based on a selective foundation, these skills are referred to

as competencies and “the qualification will be based on competencies” (Rogers, 1989, p

50). In order for a learner to acknowledge and understand a specific skill it must be

dissected into sub-components so that the learner can visualise the importance and

relevance of each component. Students must be able to practice each sub-component of

the skill and visualise its relevance. Practice allows the learner to reinforce the skill

(Laurillard, 1997).

Addressing students’ needs

In every classroom, one may find people of mixed ability; how can the teacher meet the

learning needs of all students? Rogers (1989) relates the need to break away from one-

pace teaching to use flexibly-paced, multi-resourced learning strategies, also by setting

clear objectives and ensuring that everyone meets these using a set standard to indicate

achievement. Initially, the teacher needs to explore who the students are in the group, set

6
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

out the housekeeping rules for the class group and objectives for teaching on the course.

It is important to relax the students and allow students to set their own learning objectives

and later involve them in project work to support their learning (Gosling, 2003).

Brookfield, (1996) provides a summary of the components of students’ learning needs

and explores how to implement an environment conducive to learning. He suggests that

students’ learning needs can be met when teaching is facilitative rather than didactic and

when the teacher acknowledges the learning needs, past experiences, relevant application

and individual styles of learning of students when designing learning activities. Findings

from my study on the student experience of studying to become independent nurse

prescribers support these considerations (Banning, 2004). Students’ conceptions of adult

learning involved the need to comprehend the relevance of theory in order to apply and

assimilate it and also to be offered opportunities to share vicarious experiences with

peers. The exploration of students’ views revealed the need for constructivist teaching

methods (Hendry et al., 1999), rather than knowledge transmission to teach the applied

pharmacology component of the course (Banning, 2004).

Assessing learning within classroom situations

Laurilliard (2002) reminds us that students attend courses with their individual presage

variables. These variables provide some insight on the subtle differences that illustrate

the uniqueness of each adult learner. These variables include; motivation, expectations,

knowledge retention in relation to short and long term memory, knowledge, skills,

7
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

competencies and experience, powers of concentration, problem solving ability, access to

student support facilities, study time available, learning capacity and orientation to

learning (Walkin, 2000). These variables influence the capacity for students to learn. The

teacher needs to assess learning achievement in order to proceed with the curricular

content but also to ensure students are maintaining the pace of learning. In my study, I

found that the mature learners experienced difficulties maintaining the pace of learning

when the rate of learning was much slower. This inability to maintain the pace of learning

caused extreme anxiety, distress and unhappiness amongst students (Banning, 2004).

This feature agrees with previous studies and is not uncommon in professionals who have

employment and domestic responsibilities (Jarvis, 1983).

Perhaps the most common method of assessing student learning involves objective

questioning during teaching. Effective teaching strategies that encourage answers to

simple, uncomplicated questions followed through by more complex questions or tasks

enables the teacher to explore the depth of comprehension of students. In situations where

students have been preconditioned not to question by indoctrination into apprenticeship

style teaching, diffident students can be encouraged to communicate with peers and

lecturers using quizzes, formative assignments, think-aloud seminars, self-assessment

work, group work, problem solving scenarios, case analysis, role play, simulations, film

critiques, speed reading and research appraisal (Lee & Ryan-Wenger, 1997). These

teaching and learning methods can encourage creative discussion and provide

opportunities for teachers to offer meta-cognitive questions to stimulate students to think

critically make associations between theory and practice, openly debate and think

8
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

laterally using their personal and learning experience and new knowledge to develop

understanding (Gregory, 2002).

Promoting graduateness in students

Graduates may be differentiated by their ability to critically think, use problem solving

strategies to solve enigmas and incorporate evidence and research mindedness to justify

decisions and solutions. The concept of graduateness refers to the development and

utilisation of both intellectual and transferable skills that encompass structured reflection,

critical thinking, analytical skills, leadership, research awareness, creative thought and

reasoning strategies. Critical thinking is conceptualised as an intellectual ability which

involves a reflective dimension. It is also a process which can be fostered by creative

thought, challenging the accuracy and validity of assumptions, beliefs and the context of

problem, the capacity to imagine and explore alternatives, and formulate alternatives

(Brookfield, 1987). Learners who portray critical thinking ability may challenge trigger

events, appraise or explore a situation following a trigger event then develop alternative

perspectives and integrate the event.

Although critical thinking is an important skill that encourages individuals to be

objectively analytical and reflective, both elements are essential for professional

effectiveness (Argyris & Schön, 1995) but arguably not all learners have the capability to

become critical thinkers. So, teachers need to motivate and engage students in learning to

assist this form of development. Many students attribute their poor performance to

9
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

personal characteristics and therefore fail to sufficiently engage in deep learning, often

due to devaluation of the benefits of education (Hufton et al., 2002).

Preparing students for new roles and responsibilities

To prepare learners for new roles and responsibilities they need to acquire both

professional and university education to develop professional performance. To become

an experienced clinician who is proficient in clinical reasoning, a nurse has to attain

specific clinical practice and develop nursing judgment, supported by a graduate

academic background (O’Neill & Dluhy, 1997). This combination can provide a

foundation for cognitive and psychomotor skill development that is essential for

proficient clinical reasoning (Cooke & Moya, 2002).

Although clinical reasoning is the hallmark of the nursing expert (Davies & Hughes,

1995), the debate on the sub-components of it continues (Flower, 1997). Proposed sub-

components include reflection, critical thinking, diagnostic reasoning, nursing experience

and nursing judgment. Reflection can be construed as a cognitive processing aspect of

critical thinking (O’Neill & Dluhy, 1997); thus, it is an important skill. Reflection can be

achieved by structured processing of experiences and teacher–centred problem-solving

exercises (Seymour et al., 2003, Liimatainen et al., 2001). Students can reiterate

“significant experiences of learning to others which is itself a reflective way for both the

teller and the audience to learn more about the experience by interactively weaving

together theory and practice with humane threads” (Cortazzi et al., 2001, p257).

10
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

The students’ learning of new roles needs to be assessed both theoretically and clinically.

The value of the assessment can only be as a credible as the individual assessor (While,

1994). Clinical assessors need to be familiar with assessment strategies, professional

roles and guidance and instruction on the assessment and mentoring of students (Myrick

& Yonge, 2001). Networking strategies can also be a useful support (Watkins, 2000,

Duffy & Watson, 2001).

The inclusion of multiple forms of assessments would help students integrate, synthesize

and assimilate the theoretical components of the new roles with the clinical application

and practical skills involved. This approach is valuable as it would not only incorporate

strategies to promote critical thinking but would also be a powerful tool to assess the

overall performance and ability of students to clinically reason and can serve as a safety

net if performance is below average in any assessment. Opportunities should be available

for students who fail an assignment to demonstrate that with increasing nursing

experience and consolidation of theory with practice, academic and clinical performance

can improve. Moreover, this approach can encourage the student to problem-solve,

undertake team work, learn from peers, enhance the integration, synthesis and

conceptualization of knowledge (Cooke & Moya, 2002).

An important aspect of professional competency is feedback on clinical performance and

this is a requisite indicator for learner development and confidence building. Ideally,

students should be provided with feedback on clinical performance. The feedback

11
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

sandwich is a useful approach to communicate performance (Glover, 2000). Clinical

assessors should be encouraged to utilize this method with students.

The experience of learning and achievements encountered can be reflected on and a

narrative account provided (Gallacher, 2001). The narrative can then be used to assess the

students’ clinical reasoning skills in particular their cognitive skills, critical thinking or

situation-bound thinking and personal reflection (Fowler, 1997).

Conclusion

Three approaches to established, each has its own merits and usefulness in adult learning.

The use of didactic and self directed approaches to teaching should be limited and

approaches that are student-centred such as process oriented approaches to teaching

should be encouraged particularly in teaching scientific topics, questioning and preparing

nurses for prescribing roles. Learning facilitation should be encouraged with effective

preparation strategies in place to train lecturers to effectively use these methods.

References

Banning, M, (2003). Pharmacology Education: A theoretical framework of applied

Banning, M. (2004). An illuminative evaluation of the teaching and learning experience of

12
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

Brookfield, S.D. (1987).Developing Critical Thinkers. Challenging Adults to Explore

Brookfield, S.D. (1996). Understanding and Facilitating Adult Learning. Milton Keynes:
Open University Press. pp.1-49.

Brownhill, B. (2002). The Socractic Method. In P.Jarvis (Ed). The Theory and Practice of
Teaching. London:Kogan Page. pp.70-78.
Clancy, J., McVicar, A. & Bird. D. (2000). Getting it right ?. An exploration of issues relating
to the biological sciences in nurse education and nursing practice. Journal of Advanced
Nursing, 32: 1522-1532.
Cooke, M. & Moya, K. (2002). Students’ evaluation of problem-based learning. Nurse
Education Today, 22: 330-339.
Cortazzi, M., Jin, L., Wall, D. & Cavendish, S. (2001). Sharing learning through
narrative communication. International Journal of Communication Disorders, 36,
supplement 2001: 252-257.

Davies, S., Murphy, F. & Jordan, S. (2000). Bioscience in the pre-registration curriculum:
finding the right teaching strategy. Nurse Education Today, 20: 123-135.

Entwistle, N. (1997). Contrasting Perspectives on Learning. In The Experience of Learning.

Freeth, D. & Parker, P. (2003). Key aspects of teaching and learning in nursing and
midwifery. In H., Fry, S. Ketteridge, S. & S. Marshall. (Eds) A Handbook of Teaching &
Learning in Higher Education. Enhancing Academic Practice. 2nd Edition, London: Kogan
Page. pp. 324-343.
Fry, H., Ketteridge, S. & Marshall, S. (2003) (Eds). A Handbook for Teaching & Learning in
Higher Education. Enhancing Academic Practice. 2nd Edition, London: Kogan Page. pp. 9-26.
Gregory, J. (2002). Facilitation and facilitator style. In P.Jarvis (Ed). The Theory and Practice of

Teaching. London: Kogan Page, pp 79-93

Hendry. G.D., Frommer, M. & Walker, R.A. (1999). Constructivism and problem-based

learning. Journal of Further and Higher Education, 23, 359-371.

13
Nurse Education Today, Volume 25, Issue 7, Pages 502-508

14