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A case for review of anatomy and physiology
Teaching and Learning in Nursing (2009) 4, 42–46
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A case for review of anatomy and physiology Patricia C. Jenkins EdD, MSN, RN⁎ Roane State Community College, 145 Channel Drive, Harriman, TN 37748, USA KEYWORDS Anatomy and Physiology; Review; Learning
Abstract Nursing faculty must make decisions about course content. Thus, the question arises as to whether nursing students think it is helpful to include a review of anatomy and physiology prior to discussing the nursing care. An instructor and course-specific assessment revealed that students believed it was beneficial. This finding is consistent with the teaching/learning literature, which stresses the importance of linking past learning to new learning (Smilkstein [2003]. We're born to learn. Thousand Oaks: Corwin Press; Sousa, D.A. [2005]. How the brain learns. 3rd ed. Thousand Oaks: Corwin Press). © 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Nursing faculty, like faculty teaching in other disciplines, must decide how best to utilize their class time, and this necessitates making decisions about what content to address in class and, thus, what content to address only via assigned readings. Palmer (1998) speaks to this struggle when discussing the idea that all disciplines contain core concepts that will facilitate students' understanding of the course content and also help students learn to think as someone in a particular discipline thinks. Nursing faculty face a similar struggle with so much content that could possibly be addressed in class. In light of the dilemma of what to include, the question arises whether it is prudent to devote a portion of class time to briefly review previously acquired knowledge of anatomy and physiology. The two questions explored in this article are (a) Does the literature on teaching and learning as well as how the brain learns offer any insight to this dilemma? and (b) Do associate degree nursing students enrolled in their second medical–surgical nursing course, which addresses nursing care of adults and children with alterations in six body systems, perceive that a brief review of anatomy and ⁎ Corresponding author.
physiology prior to discussing nursing care of adult patients with alterations in each of these body systems is an appropriate use of class time?
1. Literature review One concept emerging from the literature on teaching and learning is the idea of different learning preferences, which is framed in a variety of ways. Gardner (1983, 1993) presents his theory of multiple intelligence. Fairhurst and Fairhurst (1995) draw upon temperament and personality theory, and Tobias (1994) utilizes Gregoric's model of individual preferences for perceiving information and then utilizing that information. Mollan-Masters (1997), Tobias (1994), and Fairhurst and Fairhurst (1995) provide insight into various learning styles and discuss how to facilitate learning for the various learning preferences. Just as people have different preferences to learn, individual teachers vary in their preferred teaching methods (Banner & Cannon, 1999; Fairhurst & Fairhurst, 1995; Palmer, 1998; Sousa, 2005; Liesveld & Miller, 2005). Liesveld and Miller (2005) expand on the concept of diversity of teaching preferences. In their book, Teach With Your Strengths, they differentiate between a person's talent,
1557-3087/$ – see front matter © 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2008.09.004
A case for review which they describe as innate, and their strength, which requires the addition of knowledge and skill. More specifically, “the strengths of great teachers are based on talent, but they also contain one part skill and one part knowledge” (Liesveld & Miller, 2005, p. 56). Furthermore, they describe characteristics of 34 talents and discuss how these might manifest as a strength in a teacher. Palmer (1998) believes that good teaching is more than technique. He presents the idea that “perhaps the classroom should be neither teacher-centered nor student-centered but subject-centered” (p. 116). Palmer (1998) expresses the opinion that teachers might use a variety of methods when focusing on the subject, and he describes how he prefers to accomplish this as opposed to the approach of one of his mentors. Specifically, Palmer (1998) prefers sitting in a circle and leading an inquiry into the subject. This is in stark contrast to one of his mentors who lectured the entire class period. In depicting this particular mentor, Palmer (1998) states, “His classes were mostly monologues, and his students rarely played any role other than audience” (p. 22). However, despite the lack of student classroom interaction, this professor positively impacted Palmer as he knew his subject well and demonstrated a passion for his subject and for his students to know his subject (Palmer, 1998). Regardless of how one frames the issue of teaching preferences, two consistent themes emerge. One, the best teachers know their subject well (Bain, 2004; Banner & Cannon, 1999; National Research Council, 2000). Second, there is no one best method of teaching (Bain, 2004; National Research Council, 2000; Palmer, 1998; Banner & Cannon, 1999). As stated so clearly in How People Learn: asking which teaching technique is best is analogous to asking which tool is best—a hammer, a screwdriver, a knife, or pliers. In teaching as in carpentry, the selection of tools depends on the task at hand and the materials one is working with. (National Research Council, 2000, p. 22).
Although teaching and learning preferences depend on the individual, what does it mean to learn? What parts of the brain are involved with different kinds of learning? What does the brain require for learning to occur? What happens in the brain when learning occurs? How is learning defined— especially as it relates to brain processes? And, what is the role of the teacher in facilitating learning? Smilkstein (2003) draws attention to the natural function of the brain to think, learn, and remember. She states, “Human beings are born with a brain that learns by natural, innate processes” (p. 50) regardless of personality or learning style preference. Smilkstein (2003) develops the concept that people with different aptitudes and interests require varying amounts of time and effort to learn different skills, concepts, or knowledge. She also discusses how the brain changes during learning stating, “As we are growing dendrites and making synaptic connections—that is, as we are learning— neurons are being connected into networks” (Smilkstein, 2003, p. 56). Furthermore, she relates the time factor
43 involved in learning to the changes occurring in the brain because growing dendrites and making the synaptic connections require time (Smilkstein, 2003). Various regions of the brain are involved with different processes. Some of these processes are controlled processes, which require conscious attention, and others are automatic processes, which do not require conscious effort. Controlled processes involve the frontal and prefrontal cortex, whereas automatic processes concentrate in the occipital, parietal, and temporal lobes (Restak, 2006). Restak (2003; 2006) emphasizes that although the brain is capable of performing many processes at the same time, the brain is only able to consciously pay attention to a few tasks at the same time. The function of the prefrontal cortex is a uniquely human function and involves the cognitive processes of problem solving, paying attention, and maintaining control of our emotions (Medina, 2008; Restak, 2006). In addition to the prefrontal cortex, the subcortical structures of the amygdala and the hippocampus contribute to learning (Sousa, 2005; Medina 2008). Medina (2008) describes the function of the amygdala as follows: “The amygdala is responsible for both the creation of emotions and the memories they generate” (p. 40). The role of the hippocampus is to change short-term memories (working memory) into long-term memories (Medina, 2008; Kandel, 2006; Sousa, 2005). Surprisingly, “memories are not stored as a whole in one place” (Sousa, 2005, p. 51). Rather, various aspects of a memory are stored in different places in the brain and then reassembled upon recall (Medina, 2008). Research reveals that learning causes physical changes in the brain and nerve cells (Kandel, 2006; Medina 2008; Sousa, 2005). In describing this process, Medina (2008) states, “As neurons learn, they swell, sway and split” (p. 57) and form new connections. Smilkstein (2003) refers to learning as involving the growth of dendrites and the development of synaptic connections in the brain and discusses that these structural changes impact the brain's functional organization. Thus, learning, which produces changes in the brain, requires paying attention, attaching meaning, and devoting time to processing and reprocessing the information. The continual processing and reprocessing are critical for information to transfer from short-term memory into long-term memory. Without these, the information is more likely to be forgotten (Sousa, 2005). Sousa (2005) stresses that “the degree of meaning attributed to new learning will determine the connections that are made between it and other information in long-term storage” (p. 136). In other words, past experiences serve as a filter and help the learner to notice information that has meaning (Sousa, 2005). Certainly, learning refers to the process of acquiring new knowledge and new skills (Sousa, 2005). Another way to frame the concept of learning requires constructing it in terms of the changes in the brain—the growth of dendrites and the development of synaptic connections (Smilkstein, 2003). “While learning does not increase the number of brain cells, it does increase their size, their branches, and their
44 ability to form more complex networks” (Sousa, 2005, p. 78). To retain the newly acquired knowledge and skills for future use, the information has to be stored in long-term memory in such a manner that it can be located, identified, and retrieved because information that has no meaning or does not make sense tends to be forgotten (Sousa, 2005). Attaching meaning, clearly, has a great impact on learning, and the teacher has the task of helping students link the new information to a concept or some information that is already known (Smilkstein, 2003; Sousa, 2005). “The more connections that students can make between past learning and new learning, the more likely they are to determine sense and meaning and thus retain the new learning” (Sousa, 2005, p. 138).
2. Method The associate degree nursing program at Roane State Community College (RSCC) is a multicampus program and offers different sections of the same course on various campuses. In addition, the faculty that teach a particular course often vary from one campus to another but share a common course syllabus, common textbooks, common reading assignments, and often common test dates. This is similar to what occurs with faculty teaching other general education courses who share a common syllabus, common textbook, and common assignments but vary in their teaching preference and strengths. The program structure at RSCC provides a unique opportunity for faculty to assess specific aspects of their course (in addition to the college faculty evaluation system and the nursing program course evaluation) for improving some particular aspect of their course or their teaching (Astin, 1993; Gay, 1996). Two nursing courses at RSCC address nursing care of the adult and child with alterations in various body systems. The first course, Adult and Child Health I, is a 6-hour course, which is offered in the spring semester of the first year. “This course introduces the student to pediatric and adult medical–surgical concepts within the framework of the nursing process” (RSCC 2008–2010 Catalog, p. 112). The course content includes nursing care of patients with alterations in “…fluids and electrolytes; orthopedic, EENT, oncologic, and hematologic disorders; and dysfunctions of the integumentary and reproductive systems” (RSCC 2008–2010 Catalog, p. 112). The second nursing course, Adult and Child Health II, is a 10-hour course and is offered in the fall semester of the second year. It addresses nursing care of patients with alterations in the gastrointestinal, cardiac, respiratory, neurologic, endocrine, and renal body systems (RSCC 2008–2010 Catalog). At least two faculty teach each section of these courses. At minimum, one faculty member will teach the adult content and another will teach the pediatric content. In Adult and Child Health II, approximately two thirds of the content relates to care of the adult, and one third relates to care of the pediatric patient. The contact time allotted to nursing care of adult patients with
P.C. Jenkins alterations in each of the 6 body systems covered in this course is as follows: gastrointestinal system including diabetes mellitus —10 hours, cardiac system—12 hours, respiratory system—8 hours; neurologic system—12 hours, renal and endocrine systems (excluding diabetes)—10 hours. Because the adult portion in each section is not taught by the same person, the delivery of the adult content varies somewhat from campus to campus and section to section. Therefore, to ascertain whether students enrolled in one particular section of their secondsemester medical–surgical nursing course, which addresses nursing care of adults and children with alterations in six body systems, perceived that a brief review of anatomy and physiology prior to discussing the nursing care of patients with alterations in each of these body systems was an appropriate use of class time, it was necessary to ask students this question as the standard course evaluation instrument did not include this type of course/instructor specific question. A questionnaire was developed in spring 2007 to elicit student feedback on some instructor-specific questions that were not addressed in the standard course evaluation instrument, including the questions regarding the review of anatomy and physiology in an effort to improve certain aspects of the course (Astin, 1993; Gay, 1996). Students were asked to agree or disagree with the following two statements: (a) The review of anatomy and physiology at the beginning of each unit was helpful. (b) The review of anatomy and physiology should be eliminated to allow additional time to cover specific disease processes. In addition to the specific questions with the agree or disagree option, there was the opportunity following each question for students to provide comments in the section labeled additional comments. The questionnaire was administered to all students successfully completing the second medical–surgical nursing who subsequently enrolled for their last two nursing classes on the same campus the following semester. The questionnaire, which was to be completed anonymously, was administered to 28 students in spring 2007 and to 16 students in spring 2008. It is important to note that the questionnaire did not elicit the feedback of students (n = 3) in spring 2007 who successfully completed the second medical–surgical nursing course but decided to enroll in sections of the subsequent nursing courses on another campus. However, it did include all students who successfully completed the second medical–surgical nursing course in spring 2008 because all of these students enrolled in the two subsequent nursing courses on the same campus. Descriptive statistics were utilized to analyze the numerical results (Gay, 1996). The student comments to each of the questions were also analyzed and then categorized according to recurring themes (Merriam, 1998).
3. Results In fall 2006, 31 students successfully completed Adult and Child Health II for the section surveyed. In spring 2007,
A case for review Table 1
45 Table 3
Spring 2007 (25 respondents)
Questions
Agree
The review of anatomy and physiology at the beginning of each unit was helpful. The review of anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
100% (25/25)
0
Disagree 0%
92% (23/25)
No response
Questions
0%
The review of 97.6% (40/41) 2.4% (1/41) 0% anatomy and physiology at the beginning of each unit was helpful. The review of 2.4% (1/41) 90.2% (37/41) 7.3% (3/41) anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
8% (2/25)
28 students were enrolled in their last two nursing courses on the same campus, and 3 were enrolled in their last two courses on another campus. Of those 28 students, 25 completed the anonymous questionnaire, which is a return rate of 89.3%. As reflected in Table 1, of the 25 returning the questionnaire in spring 2007, 100% responded that the review of anatomy and physiology was helpful. In regard to whether the review of anatomy and physiology should be eliminated, 92% or 23 of the 25 disagreed with the statement and 2 students did not respond. Themes from student comments in 2007 regarding the review of anatomy and physiology being helpful included that it had been 2 or more years since taking anatomy and physiology, it helps students understand the material, and “getting how the system works together in your head makes learning new information easier.” One student expressed that although the review was helpful, students should already know this content. A consistent comment theme from both questions was that the review should be brief, but students did not designate a particular amount or percent of time. (Currently, the review of anatomy and physiology involves on average a little more than an hour of class time per body system.) In the spring of 2008, all students who completed the second medical–surgical nursing course in fall 2007 enrolled
Table 2 Questions
Spring 2008 (16 respondents) Agree
Disagree
Combined responses (Total respondents = 41)
No response
The review of 93.8% (15/16) 6.3% (1/16) 0% anatomy and physiology at the beginning of each unit was helpful. The review of 6.3% (1/16) 87.5% (14/16) 6.3% (1/16) anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
Agree
Disagree
No response
in the subsequent nursing courses on the same campus; thus, all students progressing to their last semester were administered the questionnaire. All 16 students returned their survey. Table 2 depicts the results from the spring 2008 survey. Of the 16 students, 15 (93.8%) thought the review of anatomy and physiology was helpful, whereas 1 student (6.3%) did not. In regard to whether the review of anatomy and physiology should be eliminated, 14 of the 16 (87.5%) respondents did not believe the review should be eliminated. One student (6.3%) thought it should be eliminated, and one student (6.3%) did not respond. In regard to the comments from spring 2008, fewer students responded to these questions, and the number and extent of the comments were also noticeably less. However, comments did identify a similar theme as the previous year in regard to the review of anatomy and physiology being beneficial. Again, one student expressed the opinion that students should know the anatomy and physiology content, and one student commented that “maybe shorten it, don't eliminate.” Table 3 depicts the combined responses of all students (N = 41) returning the survey (spring 2007 and spring 2008). Approximately, 98% of respondents agree that the review of anatomy and physiology at the beginning of each unit was helpful, and more than 90% did not think the review should be eliminated.
4. Discussion Learning occurs by connecting the new information to something previously learned (National Research Council, 2000; Smilkstein, 2003; Sousa, 2005). More specifically, Smilkstein (2003) emphasizes that “dendrites do not grow from nothing.” (p. 92). She goes on to elaborate that “they [dendrites] grow from what is already there. Thus, to teach or learn something new, we must always start with something familiar and progress from there” (p. 92). This provides a theoretical foundation for beginning a unit with a review of anatomy and physiology. It is interesting to find that most students responding to the questions indicated that the review
46 of anatomy and physiology was helpful. Likewise, most students did not think that the review of anatomy and physiology should be eliminated. The comments provided more insight into the statistical data as clear themes were evident from the various comments. Some of the comments identified that it had been 2 or more years since taking anatomy and physiology, and thus, the review was beneficial. Of particular interest was one student's comment, which seemed to reflect insight into the learning process. This student stated that “getting how the system works together in your head makes learning new information easier.” Thus, the statistical data and the comments of students were consistent with the importance of linking new information to students' preexisting knowledge. The preexisting knowledge in this case is the foundational knowledge of anatomy and physiology. The data support continuing this practice and seem to indicate that this review facilitated students' ability to understand the nursing care. However, to more clearly ascertain whether students perceive that the review of anatomy and physiology does facilitate their understanding of the pathophysiology and the subsequent nursing care, the survey questions should be revised. This will be an opportunity for further investigation and clarification. Another limitation of this course and instructor-specific assessment is that it did not include all students who successfully completed Adult and Child Health II because for convenience, students enrolling in the remaining two nursing courses on another campus were not surveyed. This involved only three students in spring 2007 as all students were surveyed in spring 2008. A third limitation is that this study was a course- and instructor-specific type of assessment, and thus, the results might be considered applicable only to the course and instructor involved in the survey.
5. Conclusion The review of anatomy and physiology of various body systems is beneficial and should be retained as indicated by most students completing the questionnaire. This finding is consistent with information gleaned from the literature. This type of course-specific information is
P.C. Jenkins important for the instructor when preparing to teach a course of this nature, which has a large amount of content to be covered. This data may provide useful information to faculty when deciding how to best use class time as they strive to facilitate students' acquisition of course content as well as facilitate students' ability to think like a nurse. In addition, this type of information may be useful for new faculty who are preparing to teach a course of this nature for the first time.
References Astin, A. (1993). Assessment for excellence. Phoenix: The Oryx Press. Bain, K. (2004). What the best college teachers do. Cambridge: Harvard University Press. Banner, J. M., & Cannon, H. C. (1999). The elements of learning. New Haven: Yale University Press. Fairhurst, A. M., & Fairhurst, L. L. (1995). Effective teaching, effective learning—Making the personality connection in your classroom. Palo Alto: Davies-Black Publishing. Gardner, H. (1983). Frames of mind: The theory of multiple intelligences. New York: Basic Books. Gardner, H. (1993). Multiple intelligences: The theory in practice. New York: Basic Books. Gay, L. R. (1996). Educational research—Competencies for analysis and application, 5th ed. Englewood Cliffs: Prentice Hall, Inc. Kandel, E. R. (2006). In search of memory. New York: W.W. Norton & Company. Liesveld, R., & Miller, J. A. (2005). Teach with your strengths. New York: Gallup Press. Medina, J. (2008). Brain rules. Seattle: Pear Press. Merriam, S. B. (1998). Qualitative research and case study applications in education. San Francisco: Jossey-Bass Publishers. Mollan-Masters, R. (1997). You are smarter than you think, 2nd ed. Ashland: Reality Productions. National Research Council. (2000). How people learn. Washington, DC: National Academy Press. Palmer, P. J. (1998). The courage to teach. San Francisco: Jossey-Bass Publishers. Restak, R. (2003). The new brain. New York: Rodale. Restak, R. (2006). The naked brain. New York: Three Rivers Press. Smilkstein, R. (2003). We're born to learn. Thousand Oaks: Corwin Press. Sousa, D. A. (2005). How the brain learns, 3rd ed. Thousand Oaks: Corwin Press. Tobias, C. U. (1994). The way they learn. Wheaton: Tyndale House Publishers, Inc.
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A case for review of anatomy and physiology Patricia C. Jenkins EdD, MSN, RN⁎ Roane State Community College, 145 Channel Drive, Harriman, TN 37748, USA KEYWORDS Anatomy and Physiology; Review; Learning
Abstract Nursing faculty must make decisions about course content. Thus, the question arises as to whether nursing students think it is helpful to include a review of anatomy and physiology prior to discussing the nursing care. An instructor and course-specific assessment revealed that students believed it was beneficial. This finding is consistent with the teaching/learning literature, which stresses the importance of linking past learning to new learning (Smilkstein [2003]. We're born to learn. Thousand Oaks: Corwin Press; Sousa, D.A. [2005]. How the brain learns. 3rd ed. Thousand Oaks: Corwin Press). © 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Nursing faculty, like faculty teaching in other disciplines, must decide how best to utilize their class time, and this necessitates making decisions about what content to address in class and, thus, what content to address only via assigned readings. Palmer (1998) speaks to this struggle when discussing the idea that all disciplines contain core concepts that will facilitate students' understanding of the course content and also help students learn to think as someone in a particular discipline thinks. Nursing faculty face a similar struggle with so much content that could possibly be addressed in class. In light of the dilemma of what to include, the question arises whether it is prudent to devote a portion of class time to briefly review previously acquired knowledge of anatomy and physiology. The two questions explored in this article are (a) Does the literature on teaching and learning as well as how the brain learns offer any insight to this dilemma? and (b) Do associate degree nursing students enrolled in their second medical–surgical nursing course, which addresses nursing care of adults and children with alterations in six body systems, perceive that a brief review of anatomy and ⁎ Corresponding author.
physiology prior to discussing nursing care of adult patients with alterations in each of these body systems is an appropriate use of class time?
1. Literature review One concept emerging from the literature on teaching and learning is the idea of different learning preferences, which is framed in a variety of ways. Gardner (1983, 1993) presents his theory of multiple intelligence. Fairhurst and Fairhurst (1995) draw upon temperament and personality theory, and Tobias (1994) utilizes Gregoric's model of individual preferences for perceiving information and then utilizing that information. Mollan-Masters (1997), Tobias (1994), and Fairhurst and Fairhurst (1995) provide insight into various learning styles and discuss how to facilitate learning for the various learning preferences. Just as people have different preferences to learn, individual teachers vary in their preferred teaching methods (Banner & Cannon, 1999; Fairhurst & Fairhurst, 1995; Palmer, 1998; Sousa, 2005; Liesveld & Miller, 2005). Liesveld and Miller (2005) expand on the concept of diversity of teaching preferences. In their book, Teach With Your Strengths, they differentiate between a person's talent,
1557-3087/$ – see front matter © 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2008.09.004
A case for review which they describe as innate, and their strength, which requires the addition of knowledge and skill. More specifically, “the strengths of great teachers are based on talent, but they also contain one part skill and one part knowledge” (Liesveld & Miller, 2005, p. 56). Furthermore, they describe characteristics of 34 talents and discuss how these might manifest as a strength in a teacher. Palmer (1998) believes that good teaching is more than technique. He presents the idea that “perhaps the classroom should be neither teacher-centered nor student-centered but subject-centered” (p. 116). Palmer (1998) expresses the opinion that teachers might use a variety of methods when focusing on the subject, and he describes how he prefers to accomplish this as opposed to the approach of one of his mentors. Specifically, Palmer (1998) prefers sitting in a circle and leading an inquiry into the subject. This is in stark contrast to one of his mentors who lectured the entire class period. In depicting this particular mentor, Palmer (1998) states, “His classes were mostly monologues, and his students rarely played any role other than audience” (p. 22). However, despite the lack of student classroom interaction, this professor positively impacted Palmer as he knew his subject well and demonstrated a passion for his subject and for his students to know his subject (Palmer, 1998). Regardless of how one frames the issue of teaching preferences, two consistent themes emerge. One, the best teachers know their subject well (Bain, 2004; Banner & Cannon, 1999; National Research Council, 2000). Second, there is no one best method of teaching (Bain, 2004; National Research Council, 2000; Palmer, 1998; Banner & Cannon, 1999). As stated so clearly in How People Learn: asking which teaching technique is best is analogous to asking which tool is best—a hammer, a screwdriver, a knife, or pliers. In teaching as in carpentry, the selection of tools depends on the task at hand and the materials one is working with. (National Research Council, 2000, p. 22).
Although teaching and learning preferences depend on the individual, what does it mean to learn? What parts of the brain are involved with different kinds of learning? What does the brain require for learning to occur? What happens in the brain when learning occurs? How is learning defined— especially as it relates to brain processes? And, what is the role of the teacher in facilitating learning? Smilkstein (2003) draws attention to the natural function of the brain to think, learn, and remember. She states, “Human beings are born with a brain that learns by natural, innate processes” (p. 50) regardless of personality or learning style preference. Smilkstein (2003) develops the concept that people with different aptitudes and interests require varying amounts of time and effort to learn different skills, concepts, or knowledge. She also discusses how the brain changes during learning stating, “As we are growing dendrites and making synaptic connections—that is, as we are learning— neurons are being connected into networks” (Smilkstein, 2003, p. 56). Furthermore, she relates the time factor
43 involved in learning to the changes occurring in the brain because growing dendrites and making the synaptic connections require time (Smilkstein, 2003). Various regions of the brain are involved with different processes. Some of these processes are controlled processes, which require conscious attention, and others are automatic processes, which do not require conscious effort. Controlled processes involve the frontal and prefrontal cortex, whereas automatic processes concentrate in the occipital, parietal, and temporal lobes (Restak, 2006). Restak (2003; 2006) emphasizes that although the brain is capable of performing many processes at the same time, the brain is only able to consciously pay attention to a few tasks at the same time. The function of the prefrontal cortex is a uniquely human function and involves the cognitive processes of problem solving, paying attention, and maintaining control of our emotions (Medina, 2008; Restak, 2006). In addition to the prefrontal cortex, the subcortical structures of the amygdala and the hippocampus contribute to learning (Sousa, 2005; Medina 2008). Medina (2008) describes the function of the amygdala as follows: “The amygdala is responsible for both the creation of emotions and the memories they generate” (p. 40). The role of the hippocampus is to change short-term memories (working memory) into long-term memories (Medina, 2008; Kandel, 2006; Sousa, 2005). Surprisingly, “memories are not stored as a whole in one place” (Sousa, 2005, p. 51). Rather, various aspects of a memory are stored in different places in the brain and then reassembled upon recall (Medina, 2008). Research reveals that learning causes physical changes in the brain and nerve cells (Kandel, 2006; Medina 2008; Sousa, 2005). In describing this process, Medina (2008) states, “As neurons learn, they swell, sway and split” (p. 57) and form new connections. Smilkstein (2003) refers to learning as involving the growth of dendrites and the development of synaptic connections in the brain and discusses that these structural changes impact the brain's functional organization. Thus, learning, which produces changes in the brain, requires paying attention, attaching meaning, and devoting time to processing and reprocessing the information. The continual processing and reprocessing are critical for information to transfer from short-term memory into long-term memory. Without these, the information is more likely to be forgotten (Sousa, 2005). Sousa (2005) stresses that “the degree of meaning attributed to new learning will determine the connections that are made between it and other information in long-term storage” (p. 136). In other words, past experiences serve as a filter and help the learner to notice information that has meaning (Sousa, 2005). Certainly, learning refers to the process of acquiring new knowledge and new skills (Sousa, 2005). Another way to frame the concept of learning requires constructing it in terms of the changes in the brain—the growth of dendrites and the development of synaptic connections (Smilkstein, 2003). “While learning does not increase the number of brain cells, it does increase their size, their branches, and their
44 ability to form more complex networks” (Sousa, 2005, p. 78). To retain the newly acquired knowledge and skills for future use, the information has to be stored in long-term memory in such a manner that it can be located, identified, and retrieved because information that has no meaning or does not make sense tends to be forgotten (Sousa, 2005). Attaching meaning, clearly, has a great impact on learning, and the teacher has the task of helping students link the new information to a concept or some information that is already known (Smilkstein, 2003; Sousa, 2005). “The more connections that students can make between past learning and new learning, the more likely they are to determine sense and meaning and thus retain the new learning” (Sousa, 2005, p. 138).
2. Method The associate degree nursing program at Roane State Community College (RSCC) is a multicampus program and offers different sections of the same course on various campuses. In addition, the faculty that teach a particular course often vary from one campus to another but share a common course syllabus, common textbooks, common reading assignments, and often common test dates. This is similar to what occurs with faculty teaching other general education courses who share a common syllabus, common textbook, and common assignments but vary in their teaching preference and strengths. The program structure at RSCC provides a unique opportunity for faculty to assess specific aspects of their course (in addition to the college faculty evaluation system and the nursing program course evaluation) for improving some particular aspect of their course or their teaching (Astin, 1993; Gay, 1996). Two nursing courses at RSCC address nursing care of the adult and child with alterations in various body systems. The first course, Adult and Child Health I, is a 6-hour course, which is offered in the spring semester of the first year. “This course introduces the student to pediatric and adult medical–surgical concepts within the framework of the nursing process” (RSCC 2008–2010 Catalog, p. 112). The course content includes nursing care of patients with alterations in “…fluids and electrolytes; orthopedic, EENT, oncologic, and hematologic disorders; and dysfunctions of the integumentary and reproductive systems” (RSCC 2008–2010 Catalog, p. 112). The second nursing course, Adult and Child Health II, is a 10-hour course and is offered in the fall semester of the second year. It addresses nursing care of patients with alterations in the gastrointestinal, cardiac, respiratory, neurologic, endocrine, and renal body systems (RSCC 2008–2010 Catalog). At least two faculty teach each section of these courses. At minimum, one faculty member will teach the adult content and another will teach the pediatric content. In Adult and Child Health II, approximately two thirds of the content relates to care of the adult, and one third relates to care of the pediatric patient. The contact time allotted to nursing care of adult patients with
P.C. Jenkins alterations in each of the 6 body systems covered in this course is as follows: gastrointestinal system including diabetes mellitus —10 hours, cardiac system—12 hours, respiratory system—8 hours; neurologic system—12 hours, renal and endocrine systems (excluding diabetes)—10 hours. Because the adult portion in each section is not taught by the same person, the delivery of the adult content varies somewhat from campus to campus and section to section. Therefore, to ascertain whether students enrolled in one particular section of their secondsemester medical–surgical nursing course, which addresses nursing care of adults and children with alterations in six body systems, perceived that a brief review of anatomy and physiology prior to discussing the nursing care of patients with alterations in each of these body systems was an appropriate use of class time, it was necessary to ask students this question as the standard course evaluation instrument did not include this type of course/instructor specific question. A questionnaire was developed in spring 2007 to elicit student feedback on some instructor-specific questions that were not addressed in the standard course evaluation instrument, including the questions regarding the review of anatomy and physiology in an effort to improve certain aspects of the course (Astin, 1993; Gay, 1996). Students were asked to agree or disagree with the following two statements: (a) The review of anatomy and physiology at the beginning of each unit was helpful. (b) The review of anatomy and physiology should be eliminated to allow additional time to cover specific disease processes. In addition to the specific questions with the agree or disagree option, there was the opportunity following each question for students to provide comments in the section labeled additional comments. The questionnaire was administered to all students successfully completing the second medical–surgical nursing who subsequently enrolled for their last two nursing classes on the same campus the following semester. The questionnaire, which was to be completed anonymously, was administered to 28 students in spring 2007 and to 16 students in spring 2008. It is important to note that the questionnaire did not elicit the feedback of students (n = 3) in spring 2007 who successfully completed the second medical–surgical nursing course but decided to enroll in sections of the subsequent nursing courses on another campus. However, it did include all students who successfully completed the second medical–surgical nursing course in spring 2008 because all of these students enrolled in the two subsequent nursing courses on the same campus. Descriptive statistics were utilized to analyze the numerical results (Gay, 1996). The student comments to each of the questions were also analyzed and then categorized according to recurring themes (Merriam, 1998).
3. Results In fall 2006, 31 students successfully completed Adult and Child Health II for the section surveyed. In spring 2007,
A case for review Table 1
45 Table 3
Spring 2007 (25 respondents)
Questions
Agree
The review of anatomy and physiology at the beginning of each unit was helpful. The review of anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
100% (25/25)
0
Disagree 0%
92% (23/25)
No response
Questions
0%
The review of 97.6% (40/41) 2.4% (1/41) 0% anatomy and physiology at the beginning of each unit was helpful. The review of 2.4% (1/41) 90.2% (37/41) 7.3% (3/41) anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
8% (2/25)
28 students were enrolled in their last two nursing courses on the same campus, and 3 were enrolled in their last two courses on another campus. Of those 28 students, 25 completed the anonymous questionnaire, which is a return rate of 89.3%. As reflected in Table 1, of the 25 returning the questionnaire in spring 2007, 100% responded that the review of anatomy and physiology was helpful. In regard to whether the review of anatomy and physiology should be eliminated, 92% or 23 of the 25 disagreed with the statement and 2 students did not respond. Themes from student comments in 2007 regarding the review of anatomy and physiology being helpful included that it had been 2 or more years since taking anatomy and physiology, it helps students understand the material, and “getting how the system works together in your head makes learning new information easier.” One student expressed that although the review was helpful, students should already know this content. A consistent comment theme from both questions was that the review should be brief, but students did not designate a particular amount or percent of time. (Currently, the review of anatomy and physiology involves on average a little more than an hour of class time per body system.) In the spring of 2008, all students who completed the second medical–surgical nursing course in fall 2007 enrolled
Table 2 Questions
Spring 2008 (16 respondents) Agree
Disagree
Combined responses (Total respondents = 41)
No response
The review of 93.8% (15/16) 6.3% (1/16) 0% anatomy and physiology at the beginning of each unit was helpful. The review of 6.3% (1/16) 87.5% (14/16) 6.3% (1/16) anatomy and physiology should be eliminated to allow additional time to cover specific diseases.
Agree
Disagree
No response
in the subsequent nursing courses on the same campus; thus, all students progressing to their last semester were administered the questionnaire. All 16 students returned their survey. Table 2 depicts the results from the spring 2008 survey. Of the 16 students, 15 (93.8%) thought the review of anatomy and physiology was helpful, whereas 1 student (6.3%) did not. In regard to whether the review of anatomy and physiology should be eliminated, 14 of the 16 (87.5%) respondents did not believe the review should be eliminated. One student (6.3%) thought it should be eliminated, and one student (6.3%) did not respond. In regard to the comments from spring 2008, fewer students responded to these questions, and the number and extent of the comments were also noticeably less. However, comments did identify a similar theme as the previous year in regard to the review of anatomy and physiology being beneficial. Again, one student expressed the opinion that students should know the anatomy and physiology content, and one student commented that “maybe shorten it, don't eliminate.” Table 3 depicts the combined responses of all students (N = 41) returning the survey (spring 2007 and spring 2008). Approximately, 98% of respondents agree that the review of anatomy and physiology at the beginning of each unit was helpful, and more than 90% did not think the review should be eliminated.
4. Discussion Learning occurs by connecting the new information to something previously learned (National Research Council, 2000; Smilkstein, 2003; Sousa, 2005). More specifically, Smilkstein (2003) emphasizes that “dendrites do not grow from nothing.” (p. 92). She goes on to elaborate that “they [dendrites] grow from what is already there. Thus, to teach or learn something new, we must always start with something familiar and progress from there” (p. 92). This provides a theoretical foundation for beginning a unit with a review of anatomy and physiology. It is interesting to find that most students responding to the questions indicated that the review
46 of anatomy and physiology was helpful. Likewise, most students did not think that the review of anatomy and physiology should be eliminated. The comments provided more insight into the statistical data as clear themes were evident from the various comments. Some of the comments identified that it had been 2 or more years since taking anatomy and physiology, and thus, the review was beneficial. Of particular interest was one student's comment, which seemed to reflect insight into the learning process. This student stated that “getting how the system works together in your head makes learning new information easier.” Thus, the statistical data and the comments of students were consistent with the importance of linking new information to students' preexisting knowledge. The preexisting knowledge in this case is the foundational knowledge of anatomy and physiology. The data support continuing this practice and seem to indicate that this review facilitated students' ability to understand the nursing care. However, to more clearly ascertain whether students perceive that the review of anatomy and physiology does facilitate their understanding of the pathophysiology and the subsequent nursing care, the survey questions should be revised. This will be an opportunity for further investigation and clarification. Another limitation of this course and instructor-specific assessment is that it did not include all students who successfully completed Adult and Child Health II because for convenience, students enrolling in the remaining two nursing courses on another campus were not surveyed. This involved only three students in spring 2007 as all students were surveyed in spring 2008. A third limitation is that this study was a course- and instructor-specific type of assessment, and thus, the results might be considered applicable only to the course and instructor involved in the survey.
5. Conclusion The review of anatomy and physiology of various body systems is beneficial and should be retained as indicated by most students completing the questionnaire. This finding is consistent with information gleaned from the literature. This type of course-specific information is
P.C. Jenkins important for the instructor when preparing to teach a course of this nature, which has a large amount of content to be covered. This data may provide useful information to faculty when deciding how to best use class time as they strive to facilitate students' acquisition of course content as well as facilitate students' ability to think like a nurse. In addition, this type of information may be useful for new faculty who are preparing to teach a course of this nature for the first time.
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