ADULT LEARNING (ANDRAGOGY)

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LITERATURE REVIEW

INTRODUCTION

In this chapter, literature consulted on three phenomena, namely adult learning, clinical reasoning and educational practices is presented and discussed. Chapter 2 therefore serves three purposes. In the first place, it is a presentation and discussion of adult learning and andragogy. Secondly, it is an in-depth description of clinical reasoning. In the third place, it is an investigation of educational practices that may influence clinical reasoning skills and an exploration of various teaching and learning strategies.
The researcher conducted an extensive electronic search of the literature utilising search engines such as the EBSCO Host Research databases, CINAHL, Science Direct and Google Scholar. The search terms used in different combinations were: adult learning/andragogy, clinical reasoning, student-centred teaching and learning strategies, nursing curriculum and nursing education which revealed a vast number of articles. Relevant articles were identified and cited throughout this chapter.

ADULT LEARNING (ANDRAGOGY)

“…the art and science of helping adults learn…”
-Malcolm Knowles-Crookes, Crookes and Walsh (2013:239) as well as Daily and Landis (2014:2066) cite Malcolm Knowles (1984) who defines andragogy as “the art and science of helping adults learn”. The adult learning theory or andragogy is based on six assumptions (refer to Section 2.2.3). The perception is that adult students, thus including nursing students, are more motivated to learn when the learning will help them to perform tasks or deal with problems in their work. They also learn most effectively when knowledge is presented in the context of application to real life situations (Burke, Barker and Marshall 2012:52). When teaching adults, it is important for the educator to recognise the essential characteristics of adult students and how these characteristics define their learning priorities and activities (Mahan and Stein 2014:141). Modern day students are typically non-traditional; they come from diverse cultural backgrounds and require teaching and learning strategies that focus on skill attainment to reinforce critical thinking and problem-solving (Stanley and Dougherty 2010:379).

HISTORICAL OVERVIEW

Between the 7th and 12th centuries, pedagogy was the only model of assumptions related to learning as well as student characteristics on which educators could base their teaching practices. Pedagogy evolved from the monastic schools of Europe and came to dominate secular schools and universities as these started to appear towards the end of the 12th century (Knowles 1970:40). The term pedagogy derives from two Greek words: paid  meaning ‘child’ and agogus meaning ‘leader of’ − thus, literally meaning leader of child which translates into the “art and science of teaching children” (Ozuah 2005:83). Pedagogical assumptions about learning and students originated from observations made by monks when teaching young children relatively simple skills (mostly reading and writing) (Knowles 1970:40). The first assumption made related to the dependent personality of the student; by implication, a student could not know his or her own learning needs. The second assumption was that learning needed to be subject-centred. The third assumption emphasised extrinsic motivation as the most important driving force for learning. Therefore, students had to be motivated by rewards and punishment; this assumption was therefore embedded in the praise versus penalty tenet. The final assumption of pedagogy was that any prior experience of the student was irrelevant, the educator need not consider the student’s prior experience (Ozuah 2005:83). With the spreading of elementary schools throughout Europe and North America later during the 18th and 19th centuries, pedagogy was adopted, adapted and reinforced because it was the only educational model at the time (Knowles 1970:40; Ozuah 2005:83) and was fundamentally a teacher-centred model (Ozuah 2005:83)
The term ‘andragogy’ was originally formulated by the German teacher, Alexander Kapp, in 1833 (Nikolova, Zafirova-Malcheva, Stefanova and Boytchev 2013:156). The terminology never quite caught on until 1926 when Eduard Lindeman wrote extensively about andragogy (Ozuah 2005:83). Andragogy, meaning ‘man’, is contrasted with pedagogy, meaning ‘child’ and agogus meaning ‘leading’ (Knowles 1973:43). Crookes, et al. (2013:239) refer to Knowles’ (1984) suggestion that andragogy is “the art and science of helping adults learn”. Several adult learning theories originated from within the organisational development field in the 1950s and 1960s as organisational development practitioners created new learning models because traditional higher education pedagogical models did not work well in the working environment (Kenner and Weinerman 2011:88).
Beginning in 1959, Malcolm Knowles expanded on the work of Eduard Lindeman. Extensive work by Knowles and other educators resulted in the development of new assumptions about adult students (Ozuah 2005:83). Pedagogy and andragogy are not mutually exclusive paradigms. Andragogy contains an appreciation and acceptance of pedagogy, which is an appropriate approach in situations where adult students are truly dependent and have no relevant prior experience (Ozuah 2005:84). As early as 1970, Knowles acknowledged that concepts of andragogy were applicable in the education of children. He wrote that andragogy is simply another model of assumptions about students used alongside the pedagogical model of assumptions applied within a given situation (Knowles 1970:43). However, practitioners of andragogy would gradually move students away from the dependency of pedagogy towards increasing autonomy and self-direction (Ozuah 2005:84).

ADULT LEARNING THEORIES

Several learning theories described in literature may help to understand aspects of adult learning (Ozuah 2005:85). According to Ozuah (2005:85), the five main theories are the behavioural theory, cognitive theory, constructivist theory, developmental theory, and the humanistic theory. These five learning theories are briefly discussed in Sections 2.2.2.1 to 2.2.2.5

Behavioural theory

The goal of learning is a change in observable behaviour (Ozuah 2005:85). According to Palis and Quiros (2014:115), stimuli in the environment can produce changes in behaviour. The behavioural theory prescribes the educator writes the learning objectives, provides the stimulus, asks for student responses, and provides reinforcement to adult students. The educator is therefore in control of the learning process (Ozuah 2005:85)

Cognitive theory

With the cognitive theory, learning focuses on mental and psychological processes and the perception and processing of information, and not on behaviour (Palis and Quiros 2014:115). The goal of cognitive theory is the acquisition of usable knowledge and problem-solving expertise (Ozuah 2005:85). Cognitive theories consider learning and thinking as social activities taking place in a community and influenced by the situation at hand (Palis and Quiros 2014:115). The educator attempts to connect new concepts to old ones and is concerned with the thought process of the student (Ozuah 2005:85).

Constructivist learning theory

Learning is the acquisition of a shared understanding and the development of the process of knowledge acquisition. The educator together with students develops the objectives and grounds the learning in practical experiences (Ozuah 2005:85). In the constructivists’ view, students generate knowledge and meaning best when they have experiences that lead them to realise how new information fits into their current understanding of a concept or idea; this theory is at the heart of all active student-centred learning (Slavich and Zimbardo 2012:572). Constructivists agree the student, rather than the educator is central to creating knowledge and gaining knowledge is an active process (Botma, Brysiewicz, Chipps, Mthembu and Phillips 2014:16-17).

Developmental theory

The goal of learning is the achievement of each student’s maximum potential. The learning objectives are based on norms, appropriate behaviours, and skills or knowledge for specific levels or stages of development. The educator determines the student’s stage and responds appropriately (Ozuah 2005:85).

Humanistic theories

Humanistic theories centre on the student. These theories focus on an individual’s potential for self-actualisation, self-direction and internal motivation (Palis and Quiros 2014:115). Based on the assumption that inherently people have a natural tendency to learn, the goal of humanistic theories is to satisfy the students’ need for professional and personal growth (Ozuah 2005:85). It includes the explanation of adults’ motivation and disposition to learning as well as self-directed learning − the suggestion that students can plan, conduct and assess their own learning (Palis and Quiros 2014:115).
Each of the learning theories has some applicable position in adult education. For example, the humanistic theory lends itself to problem-based learning and self-understanding whereas behaviourism seems to be more relevant in the teaching of practical, specific skills (Ozuah 2005:86). Andragogy is clearly the best known of these theories (Ross-Gordon 2011:28.; Goddu 2012:170). Malcom Knowles is credited for bringing this theory to attention in North America – though he acknowledged its previous European origins − and it is one of the most enduring and widely cited theories of adult learning (Ross-Gordon 2011:28). In spite of the differences between the various learning theories, several areas of agreement exist. Ozuah (2005:86) mentions some examples: the significance of having clear goals and objectives, the progression of learning from simple to more complex and abstract, active student participation, and the importance of reinforcement and feedback. Daily and Landis (2014:2065) state although many models to explain adult learning exist, the best known is andragogy as described by Malcolm Knowles and which is based on five assumptions.

ASSUMPTIONS OF ANDRAGOGY

According to Applin, Williams, Day and Buro (2011:130), adult education literature suggests adult students are self-directed, problem-centred, and filled with a sense of need to learn useful information. In 1973 Malcolm Knowles argues in his book, the adult learner: a neglected species, that the andragogical theory is based on at least four assumptions that differ from pedagogy, namely changes in self-concept, the role of experience, readiness to learn, and orientation to learning (Knowles 1973:45-48). A fifth assumption added later gave rise to Knowles’ (1980:58) view that adult learning is characterised by the five assumptions as discussed in Sections 2.2.3.1 to 2.3.3.5.

DECLARATION 
ACKNOWLEDGEMENTS 
ACKNOWLEDGEMENT OF THE ACTION RESEARCH GROUP 
ABSTRACT 
TABLE OF CONTENT 
LIST OF TABLES 
LIST OF FIGURES 
LIST OF PHOTOS 
LIST OF VIGNETTES 
LIST OF ANNEXURES 
LIST OF ACRONYMS AND ABBREVIATIONS 
CHAPTER 1: ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND AND RATIONALE
1.3 PROBLEM STATEMENT
1.4 RESEARCH QUESTION
1.5 AIM AND OBJECTIVES
1.6 SIGNIFICANCE
1.7 CONCEPTS CLARIFICATION
1.7.1 CLINICAL REASONING
1.7.2 NURSE EDUCATOR
1.7.3 UNDERGRADUATE STUDENT NURSE
1.7.4 EDUCATIONAL PRACTICES
1.8 PHILOSOPHICAL ASSUMPTIONS
1.8.1 ONTOLOGICAL ASSUMPTIONS
1.8.2 EPISTEMOLOGICAL ASSUMPTIONS
1.8.3 METHODOLOGICAL ASSUMPTIONS
1.9 THEORETICAL FRAMEWORK
1.10 DELINEATION
1.11 RESEARCH SETTING
1.12 ROLE OF THE RESEARCHER
1.13 RESEARCH DESIGN
1.14 METHODS
1.15 QUALITY INDICATORS
1.15.1 REFLEXIVITY
1.15.2 CONFIRMABILITY
1.15.3 CREDIBILITY
1.15.4 DEPENDABILITY
1.15.5 TRANSFERABILITY
1.16 ETHICAL CONSIDERATIONS
1.16.1 BENEFICENCE
1.16.2 RESPECT FOR HUMAN DIGNITY
1.16.3 JUSTICE
1.17 LAYOUT OF THE STUDY
1.18 CONCLUSION
CHAPTER 2: LITERATURE REVIEW
2.1 INTRODUCTION
2.2 ADULT LEARNING (ANDRAGOGY)
2.2.1 HISTORICAL OVERVIEW
2.2.2 ADULT LEARNING THEORIES
2.2.2.1 Behavioural theory
2.2.2.2 Cognitive theory
2.2.2.3 Constructivist learning theory
2.2.2.4 Developmental theory
2.2.2.5 Humanistic theories
2.2.3 ASSUMPTIONS OF ANDRAGOGY
2.2.3.1 Self-direction
2.2.3.2 Need to learn
2.2.3.3 Life experiences
2.2.3.4 Task, problem or inquiry-centred
2.2.3.5 Motivation
2.2.4 BEST PRACTICES FOR TEACHING ADULTS
2.3 CLINICAL REASONING
2.3.1 HISTORICAL OVERVIEW
2.3.2 DEFINING CLINICAL REASONING
2.3.3 VALUE OF CLINICAL REASONING
2.3.4 THE CLINICAL REASONING CYCLE
2.3.4.1 Consider the patient (Step 1)
2.3.4.2 Collect cues/information (Step 2)
2.3.4.3 Process information (Step 3)
2.3.4.4 Identify patient problems/issues (Step 4)
2.3.4.5 Establish goals (Step 5)
2.3.4.6 Take action (Step 6)
2.3.4.7 Evaluate outcomes (Step 7)
2.3.4.8 Reflect (Step 8)
2.3.5 TYPES OF CLINICAL REASONING
2.3.5.1 Narrative reasoning
2.3.5.2 Interactive reasoning
2.3.5.3 Procedural reasoning
2.3.5.4 Pragmatic reasoning
2.3.5.5 Conditional reasoning
2.3.6 THINKING STRATEGIES UTILISED DURING CLINICAL REASONING
2.3.6.1 Cognition and metacognition
2.3.6.2 Dual process theory
2.3.7 EVALUATING CLINICAL REASONING
2.3.7.1 Script Concordance Test
2.3.7.2 Lasater Clinical Judgement Rubric California Critical Thinking Disposition Inventory and the Health Science Reasoning Test
2.3.7.4 Diagnostic Thinking Inventory
2.4 EDUCATIONAL PRACTICES
2.4.1 CHALLENGES EXPERIENCED BY NURSE EDUCATORS
2.4.2 TEACHING AND LEARNING STRATEGIES
2.4.2.1 Think-aloud approach
2.4.2.2 Case studies
2.4.2.3 Reflective self-regulated learning
2.4.2.4 Reflection
2.4.2.5 Clinical post-conferences
2.4.2.6 Virtual learning environment
2.4.2.7 Concept-based learning
2.4.2.8 Outcome-Present State-Test Model
2.4.2.9 Questioning
2.4.3 CURRICULUM
2.5 CONCEPTUAL FRAMEWORK
2.6 CONCLUSION
CHAPTER 3: RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION
3.2 RESEARCH AIM AND OBJECTIVES
3.3 RESEARCH DESIGN
3.4 ACTION RESEARCH
3.5 RESEARCH METHODS
3.6 PHASE 1: BASELINE
3.7 PHASE 2: ACTION RESEARCH PROCESS
3.8 PHASE 3: EVALUATION OF ACTION RESEARCH PROCESS
3.9 CONCLUSION
CHAPTER 4: BASELINE (PHASE 1)
4.1 INTRODUCTION
4.2 RESEARCH METHODS
4.3 DATA ANALYSIS
4.4 OVERVIEW OF RESEARCH FINDINGS
4.5 SUMMARY OF THE FINDINGS
4.6 CONCLUSION
CHAPTER 5: ACTION RESEARCH PROCESS (PHASE 2)
5.1 INTRODUCTION
5.2 LAUNCH OF ACTION RESEARCH PROCESS
5.3 CYCLE 1: PLANNING THE WAY FORWARD
5.4 CYCLE 2: CO-CONSTRUCTING THE ACTION PLAN (1)
5.5 CYCLE 3: CO-CONSTRUCTING THE ACTION PLAN (2)
5.6 CYCLE 4: FINALISING THE ACTION PLAN
5.7 SUMMARY OF ACTION RESEARCH PROCESS
5.8 CONCLUSION
CHAPTER 6: EVALUATION OF ACTION RESEARCH PROCESS (PHASE 3)
6.1 INTRODUCTION
6.2 PARTICIPANTS
6.3 DATA COLLECTION
6.4 WORLD CAFÉ PROCESS
6.5 DATA ANALYSIS
6.6 DISCUSSION OF FINDINGS
6.7 SUMMARY OF FINDINGS
6.8 CONCLUSION
CHAPTER 7: CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS
7.1 INTRODUCTION
7.2 CONCLUSIONS
7.3 UNIQUE CONTRIBUTIONS OF THE STUDY
7.4 LIMITATIONS
7.5 RECOMMENDATIONS
7.6 REFLECTIONS
7.7 CONCLUSION
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