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Using Learning Style Preferences for Perioperative Clinical Education A
hat motivates learners to learn? What creates excitement about the process of learning? These are constant challenges for educators in all disciplines. Unlike the usual paucity of literature on most education “problems,” there is a significant amount of research in the nursing literature about the concept of learning styles. Journals devoted to nursing education, higher education, nursing staff development, nursing continuing education, and nursing management contain articles that report learning experiences and research about learning. The concept of learning styles, based on the work of David A. Kolb, PhD,’ is a popular method of assessing and explaining the learning process of nursing students2 and practicing n ~ r s e s Though .~ Kolb has received much attention in nursing literature, no one has determined how the actual theory of experiential learning is related to the multidimensional art and science of nursing practice.4 Using Dr Kolb’s ideas, researchers have defined the concept of learning as “the way individuals organize information and e~perience.”~ In any perioperative patient care setting, knowledge of how a person learns can be used by clinical educators to design and develop positive learning experiences for individuals or groups, by surgical services managers to justify costbenefit issues related to continuing education,
and by direct patient caregivers to determine which educational activities (eg, seminars, independent learning programs, hands-on experience) best meet the individual’s or group’s learning needs. This article explains the “assimilator learning style,” which is one of four learning styles in Dr Kolb’s four-stage cycle of learning, and shares examples of how this learning style can be used for perioperative education. We selected the assimilator learning style based on research that included critical care nurses, perioperative nurses, and infection control practitioners.6 This research indicates that the assimilator learning style was the preferred learning style for these groups of nurses. EXPERIENTIALLEARNING
The concept of experiential learning emphasizes the importance of experience in the process of learning. Dr Kolb uses the interaction of people and their environments as the basis of his theory of experiential learning.7 He states that learning is a cycle that includes both a sequential learning process of “doing-watching-thinking-feeling” and integrated patterns of these actions. His idea of environment refers to the time-and-place context of the learning experience. For fully integrated learning to occur, the sequential process and the integrated activity need to happen simultaneously. Learning style, therefore, is two-dimensional, but it is the A B S T R A C T integrated response that is the Individuals who use the assimilator learning style prefer to use individual’s p;eferred learning abstract conceptualization and reflective observation in learning situ- style. Dr Kolb suggests that this ations. They are logical thinkers who evaluate and carefully observe combination of learning process situations and concepts rationally before making judgments. The and learner response implies that authors constructed theoretical models that perioperative nurses a discipline (ie, environment) who are assimilators could follow in learning important concepts, tends to attract an individual who such as recommended practices. AORNJ61 (Jan 1995) 189-195. has a learning style congruent LINDA RRAZEN. RN; ROSEMARY ANN ROTH. R N
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Table 1 LEARNING STYLES
Learning style
Description
Accommodative
risk taker, adaptable' good at carrying out plans and gelting the job done2 involves self in new experiences3 learns through trial and error4
Divergent
thinks through alternative solutions to problems5 imaginative6
Convergent
less people oriented; good at applying theory to practical situations' finds practical uses for ideas and theories8
Assimilator
uses inductive reasonings good at theory building; less people oriented and less practical than other learners10 creates theoretical models" able to put a wide range of information into concise, logical form by inductive organization of the information'*
NOTES 1 . M E Highfield, "Learning styles," Nurse Educator 13 (November/December 1988) 30-32. 2. H K Laschinger, M W Boss, "Learning styles of nursing students and career choices,' Journal OfAdvanced Nursing 9 (1 984) 375-380. 3. R M Thomas, "Management team assessment A learning style inventon/," Nursing Management 17 (March 1986) 39-48. 4. B Goldrick, B Gruendemann, E Larson, "Learning styles and teachingheaming strategy preferences: Implications for educating nurses in critical care, the operating room, and infection control," Heart& Lung 22 (MarcNApril 1993) 176-182. 5 . Highfield, "Learning styles," 30-32. 6. Laschinger, Boss, "Learning styles of nursing students and career choices,' 375-380. 7. /bid. 8. Goldrick, Gruendemann, Larson, "Learning siyles and teachingllearning strategy preferences: Implicationsfor educating nurses in critical care, the operating roam, and infection control," 176-182. 9. Highfield, 'Learning styles," 30-32. 10. Laschinger, Boss, 'Learning styles of nursing students and cClreer choices," 375-380. 1 1. Thomas, "Management team assessment A learning siyle inventory," 39-48. 12. Goldrick, Gruendemann, Larson, 'Learning siyles and teaching/lebrning strategy preferences: Implicationsfor educating nurses in critical care, the operatlng roam, and infection control," 176-182.
with the discipline's structure of knowledge. WRNlNQ SWISS
A person's learning style is his or her preferred way of learning, but a person's style is not actually learned. Why a person prefers a certain way of learning more than another, or why he or she may combine one certain way with another is not known. This creates some potential research questions. Is it desirable to match teaching methods to learning styles? What do the educators of today and tomorrow
need to study or evaluate to provide learners with the best learning experiences? Which teaching methods or learning styles work best in practice environments, such as operatidg rooms, where rapid change, ambiguity, uncenainty, and explosive information and technology are the norm? The four learning styles defined by Dr Kolb and descriptions of these styles are listed in Table 1. Learning styles are the process-oriented pieces of education that belong to the learner and are different from the product-oriented pieces of education that belong 191
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used the Kolb LSI. The majority of the research was performed with nursing students who were not in OR settings; much of the research, therefore, probably is not transferable to day-to-day perioperative nursing. It seems reasonable to us that the research that compared the learning styles of critical care nurses, perioperative nurses, and infection control practitioners’7 is unique in that it is the first field report of learning styles/preferences of nurses in perioperative nursing practice. As are all studies of learning style, this research is limited because of a generally recognized lack of a clear and consistent definition of the term learning style, a relatively small and homogeneous study sample, and a less than rigorous research design for a learning style investigation. The researchers’ conclusion needs to be used and the study replicated before it is accepted as an allencompassing answer to the question, “What is the preferred learning style of perioperative nurses?” To promote quasi-pilot testing within the ranks of perioperative nurses, we used the characteristics and traits of the assimilator-type learner to construct theoretical models of two AORN recommended practices: “Recommended practices for steam and ethylene oxide (EO) sterilization” (Figure 1) and “Recommended practices for disinfection” (Figure 2).18Sterilization and high-level disinfection are core concepts of direct patient care in the operating room, and because both are based on empirical sciences, they may be considered structured knowledge of perioperative nursing practice. The theoretical model for each figure is analogous to the face of a clock. The information at each clock hour (ie, the outer circle of each figure) is structured knowledge for the procedural steps of the recommended practices. The hands of the clock (ie, the inner circle) are set at the structured knowledge for the sequential core concepts involved in sterilization and high-level disinfection. Using a model of recommended practices involved in a vital perioperative patient practice is not the same as outlining the information. Using a model supports the strengths, characteristics, and traits of the person who prefers the assimilator learning style. A model, as opposed to an outline or narrative text, provides the assimilator with a blueprint for IMPUCAliONS FOR PERIOPERATNE NURSING The results of the most recent study on Dr learning (ie, abstract conceptualization of the key Kolb’s assimilator leaming style,I6 which is the basis information to be assimilated,Iy reflective observafor this article, differ from those of other research that tion2O). If perioperative nurses prefer the assimilator
to the educator. The products of even the most expert educator (ie, one who designs educational activities, develops curricula, uses advanced teaching strategies) will not succeed with all learners because all learners do not process information in the same way. Educators who can appreciate learning style inventory and use learning style analysis, however, can successfully cultivate learning in all learners. Preferred learning styles integrate well with the core principles of adult education (ie, a learner is self-directed, a learner’s experience is to be respected, a person’s readiness to learn is related to his or her evolving social roles, adult learners are problem oriented). The Kolb learning style inventory (LSI) is a theory-based, self-report instrument that asks respondents to complete statements such as, “I learn by doing, watching, thinking, or feeling.”“’ The LSI measures a person’s strengths and weaknesses as a learner. Other researchers used the LSI to assess learning style preference among critical care nurses, perioperative nurses, and infection control practitioners.” These investigators used the LSI to test the hypothesis that there is a difference in learning style orientation among nurses in selected specialties. Three hundred three nurses responded to the survey (93% return rate). No significant differences in learning style orientation were found among the three specialty groups, although it is interesting to note that 36% of the respondents indicated that they use an abstract approach to learning and prefer self-directed approaches to learning. Dr Kolb uses the term ussirnilutor to describe this type of learning style.’* Dr Kolb describes the assimilator-oriented learner as one who prefers to use abstract conceptualization and reflective observation in a learning situation. In other words, the learner uses an analytical conceptual approach to learning that relies heavily on logical thinking, rational evaluation, and careful observation in making judgments. Another researcher states that the ability to create theoretical models is the greatest strength of the assimilator learning style.13 Another investigator describes this type of learner as “an intuitive on-the-job researcher who adapts, organizes, and analyzes information.”14 Others describe the person who prefers the assimilator leaming style as “good at theory building through inductive reasoning.”I5
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Figure 1 Information at each clock hour on the outer circle represents structured knowledge for procedural steps. Hands of the clock on the inner circle are Set at structural knowledge for the sequential care concepts of sterilization.
learning style, as the literature indicates, models such as the ones developed for the sterilization and disinfection recommended practices will enhance their ability to “feel-watch-think-do,” which are the core components of Dr Kolb’s learning process.21 CONCLUSION
Teaching/learning is a complex process with innumerable variables. Researchers have investigated the process as a whole and as separate entities without obtaining conclusive empirical findings. Learning styles are only one component of the
whole process, and the Kolb LSI is only one means of measuring preferred learning styles. The validity of the instrument alone has been challenged.21 Neither the LSI as a tool nor preferred learning styles as a concept should be confused or intermingled with other tools that have been used to assess nurses’ learning styles (eg, Gregorc style delineator, tools used to measure individual preferences of how to perceive and act in the world [Myers-Briggs type indicator]). There is much to be learned about clinical education and how perioperative nurses learn. If we are 193
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Figure 2 Information at each clock hour on the outer circle represents structured knowledge for procedural steps. Hands of the clock on the inner circle are set at structural knowledge for the sequential care concepts of disinfection.
open to investigating our long-standing patient care practices and ourselves as caregivers, it will help us Linda Brazen, RN, MS(N), CNOR, C , is continuing edudefine ourselves to the nursing community. Such cation coordinator, Centerfor Perioperative Education, research does not need to be long-tem funded pro- Association of Operating Room Nurses, Inc, Denver. jects designed to “prove” or “solve” major perioperRosemary Ann Roth, RN. MSN, CNOR, CNAA , is director ative Perioperative staff nurses’ educators’ of sui;qicai suiteslperinatal,The Genesee Hospital, Rochester, and services managers can contribute to Ny,ando lieuteriant cnmmander in the us Nai)al Reserve. research-based practice simply by using research findings in day-to-day activities, as described in this The authors acknowledge ~ ~T , Ruth, ~ editor i 0fnur.y~ l article. Simply seeing if Something Works in a pefi- ing hooks, W . B . Saunders Co, Philadelphia, who conoperative care setting is research, and it can be sim- ceived the idea,for the graphics shown in thefigures in ple, short-term, economical, and even fun. A this article. 194 AORN JOURNAL
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NOTES 1. D A Kolb, Experiential Learning: Experience as the Source of Learning and Development (Englewood Cliffs, NJ: PrenticeHall, Inc, 1984). 2. M E Highfield, “Learning styles,” Nurse Educator 13 (November/December 1988) 30-32; H K Laswchinger, M W Boss, “Learning styles of nursing students and career choices,” Journal of Advanced Nursin,? 9 (July 1984) 375-380. 3. B Goldrick, B Gruendemann, E Larson, “Learning styles and teachingflearning strategy preferences: Implications for educating nurses in critical care, the operating room, and infection control,” Heart &Lung 22 (March/April 1993) 176182; R M Thomas, “Management team assessment: A learning style inventory,” Nursing Management 17 (March 1986) 39-48. 4. V M DeCoux, “Kolb’s Learning Style Inventory: A review of its applications in nursing research,” Journal of Nursing Education 29 (May 1990) 202-207. 5. H K Laschinger, M W Boss, “Learning styles of nursing students and career choices,” Journal of Advanced Nursing 9 (1984) 375380. 6. Ibid. 7. Ibid. 8.Ibid. 9. Highfield, “Learning styles,” 30-32; Laschinger, Boss, “Learning styles of nursing students and career choices,’’ 375-380; Thomas, “Management team assessment: A learning style inventory,” 39-48; DeCoux, “Kolb’s Learning Style Inventory: A review of its applications in nursing research,” 202-207; Goldrick, Grueridernann, Larson,
“Learning styles and teachingbeaming strategy preferences: Implications for educating nurses in critical care, the operating room, and infection control,” 176-182. 10. D A Kolb, Learning Style Inventory: Technical Manual (Boston: McBer and Co, 1976) 179. 11. Highfield, “Learning styles,” 30-32; Laschinger, Boss, “Learning styles of nursing students and career choices,” 375-380; Thomas, “Management team assessment: A learning style inventory,” 39-48; DeCoux, “Kolb’s Learning Style Inventory: A review of its applications in nursing research,” 202-207; Goldrick, Gruendemann, Larson, “Learning styles and teachingbeaming strategy preferences: Implications for edlrcating nurses in critical care, the operating room, and infection control,” 176-182. 12. Kolb, Experiential Learning: Experience as the Source of Learning and Development. 13. Thomas, “Management team assessment: A learning style inventory,” 39-48. 14. Highfieid, “Learning styles,” 30-32. 15. Laschinger, Boss, “Learning styles of nursing students and career choices,” 375-380. 16. Goldrick, Gruendemann, Larson, “Learning styles and teachingAearning strategy preferences: Implications for educating nurses in critical care, the operating room, and infection control,” 176182. 17. Ibid. 18. “Recommended practices for steam and ethylene oxide (EO) sterilization,” in AORN StanBards and Recommended Practices (Denver: Association of Operating Room
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Nurses, Inc, 1993) 207-214; “Recommended practices for disinfection,” in AORN Standards and Recommended Practices (Denver: Association of Operating Room Nurses, Inc, 1993) 111-115. 19. Kolb, Experiential Learning: Experience as the Source of Learning and Development. 20. Ibid. 21. Highfield, “Leaming styles,” 30-32. SUGGESTED READING Garity, J. “Learning styIes: Basis for creative teaching and learning.” Nurse Edicc,ator 10 (March/April 1985) 12-16. Holbert, C M; Thomas, K J. “Toward whole-brain education in nursing.” Nurse Educator 13 (JanuaryiFebruary 1988) 30-34. Ismeurt, J; Ismeurt, R Miller, B K. “Field-dependence/independence: Consideration in staff development.” The Journal of Continuing Education in Nursing 23 (JanuaryiFebruary 1992) 38-41. Neuhauser, P C. “Whole-brain management: Putring innovative thinking to work in health care.” Journal of Healthcare Education and Training 1 (Fall 1986) 12-14. Partridge, R. “Learning styles: A review ofselected models.” Journal of Nursing Education 22 (June 1983) 243-248. Thompson, C; Crutchlow, E. “Learning style research A critical review of the literature and implications for nursing education.” Journal of Professional Nursing 9 (JanuaryPebruary 1993) 34-40. Worrell, P J. “Metacognition: Implications for instruction in nursing education.” Journal of Nursing Education 29 (April 1990) 170-175,