Concept-Based Teaching and Meaningful Learning in Associate Degree Nursing Students A dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of Doctor of Philosophy of the College of Nursing by Teresa J. Getha-Eby B.S.N. Miami University, 1986 M.S.N. University of Cincinnati, 1988 December 2012 Committee Chair: Theresa A. Beery, PhD, RN, ACNP-BC, CNE; Professor CONCEPT-BASED TEACHING & MEANINGFUL LEARNING Abstract This mixed methods quantitative-dominant, explanatory sequential design study investigated meaningful learning outcomes of first semester associate degree nursing students at a private nursing college in the Midwestern United States. The quantitative strand compared meaningful learning of two groups: students who received concept-based teaching (CBT) and students who received traditional nursing pedagogy. Meaningful learning was measured by higher order thinking (HOT) gain (i.e., the difference between standardized pre- and post-test scores). The instruments used to measure HOT gain were the Assessment Technologies Institute (ATI) Critical Thinking Assessment (pre-test) and the ATI Nursing Fundamentals Assessment (post- test). The quantitative data were extracted from 346 archived student records from six consecutive cohorts. The cohorts consisted of students enrolled in the first semester nursing course between spring, 2009 and fall, 2011. Three cohorts had received CBT and three had received traditional teaching. Multiple regression was used to analyze relationships between HOT gain and the potential influencing variables of teaching method, pre-test score, age, previous science coursework, and the time interval between the pre- and post-test. The findings included: (1) no significant between group differences, and, (2) a significant inverse relationship between pre-test score and HOT gain that was not influenced by teaching method. The quantitative results were used to purposefully select the qualitative sample. The qualitative sample consisted of 11 students whose HOT post-test scores were from the uppermost quartile, and 11 students whose scores were from the lowermost quartile. This maximal variation sampling technique was used to increase understanding of the mechanisms underlying the meaningful learning process. A patient case study discussion was conducted with each of the 22 CBT students during the spring semester of 2012. Transcripts of the discussions were analyzed ii using flow mapping. Flow mapping is a qualitative data analysis method in which the researcher creates a graphic representation of students’ knowledge connections. The completed flow maps fell into two distinct groups distinguished by number and type of knowledge connections. Integrative analysis found that students who verbalized a greater number of knowledge connections during the interview had higher HOT scores and a deeper understanding of principles underlying nursing interventions than did students who verbalized fewer connections. Knowledge connections and HOT appear to be associated, as predicted by meaningful learning theory. Additional research is needed to investigate CBT’s effect on this relationship. iii Copyright 2012 Teresa J. Getha-Eby All rights reserved iv Dedication To my husband, Steve, who has been a constant source of support and encouragement. v Acknowledgements I wish to extend heartfelt gratitude to all who inspired and supported my journey. To my colleagues - those at Good Samaritan College of Nursing and Health Science, those from 14CD at Good Samaritan Hospital, and those from the University of Cincinnati doctoral program. Thank you for our conversations; they stimulated my thinking. To the administrative staff at Good Samaritan College; thank you for offering flexible hours to accommodate my academic schedule. To the many students who have touched my life, further increased my passion for teaching, and from whom I continue to learn every day. I’m grateful our paths have crossed. To the members of my dissertation committee, Dr. Terry Beery, Dr. Yin Xu, and Dr. Beth O’Brien; your thought-provoking questions and feedback have nurtured my growth as a novice researcher. Thank you for your guidance. To my family members who applauded when I enrolled in the doctoral program, and cheered when I completed. To my parents, Jim and June Getha, whose values and encouragement have enriched my life and strengthened me for this journey. And to my daughters, Adrianne and Kristyn – thank you for having the interest (and courage!) to ask me how my study was progressing, and the strength to keep your eyes from glazing when I told you. I love you. This study was funded, in part, by a research grant from the University of Cincinnati’s Beta Iota Chapter of Sigma Theta Tau International vi Preface This work was completed using a manuscript dissertation format. The documents that follow include the first three chapters in standard dissertation form, followed by three manuscripts written for publication. The first chapter provides an introduction to the study problem, and support for the research investigation. Chapter Two contains a synthesis of the literature, and provides the theoretical foundation on which the study is based. The third chapter provides a detailed description of the methods used to conduct the study. The decision to use a manuscript format for this work was based on findings from the literature review. Findings from the literature review indicate that much patient care is being provided in a manner that is neither safe nor effective. This is of concern not only to nurses and nurse educators, but also to the general public. Meaningful learning in pre-licensure education is essential for nurses to provide safe and effective patient care. In order for nurse educators to implement measures that promote meaningful learning, they must first receive information about what meaningful learning is, and how it can be fostered in students. The three manuscripts are a means of disseminating this information. Each manuscript was developed in alignment with the submission guidelines for a specific nursing journal. The manuscripts follow the chapters. The first manuscript provides a description of the theory underlying meaningful learning, and an innovative pedagogy based on meaningful learning concepts and principles. The second describes a method of assessing and analyzing students’ meaningful learning. The third manuscript provides a succinct description of the study, its findings, conclusions, and implications for practice. vii Table of Contents Chapter 1: The problem Introduction of the problem . 1 Introduction to meaningful learning . 2 Meaningful learning and higher order thinking . 2 Meaningful learning and clinical judgment . 3 Pedagogies that facilitate meaningful learning . 6 Evaluating new pedagogies . 7 Purpose of the study . 8 Quantitative strand . 9 Qualitative strand . 9 Rationale for conducting the study . 10 Traditional nursing pedagogy and learning outcomes . 10 National nurse licensing trends . 12 Evidence from nurse managers and novice nurses . 13 Findings from current nursing education research . 14 Factors inhibiting implementation of newer pedagogies . 15 Innovation of the proposed study . 17 Specific Aims & research questions . 18 Specific Aims . 18 Quantitative questions . 19 Qualitative question . 20 Integrated questions . 21 Summary . 22 Chapter II: Background Introduction . 23 Overview of chapter II sections . 24 Learning paradigms: Overview . 27 Constructivism: Underlying philosophy and key theorists . 28 Early constructivist theorists . 29 John Dewey . 29 Jean Piaget . 30 Jerome Bruner . 31 David Ausubel’s theory of meaningful learning . 32 Meaningful versus rote learning . 33 The role of cognitive structure in meaningful learning . 34 The processes involved in meaningful learning . 34 Progressive differentiation . 35 Subsumption/assimilation . 35 Integrative reconciliation . 36 Formation of arbitrary connections . 36 Advance organizers in meaningful learning . 37 viii Contemporary view of constructivism & Ausubel’s theory . 37 Depth versus breadth of content . 38 Addressing learners’ underlying knowledge . 39 Cognitive engagement . 40 Summary . 40 Strategies to facilitate meaningful learning . 40 Scaffolding learning . 41 Concept-based teaching . 42 Contemporary view of meaningful learning as knowledge integration . 44 Knowledge integration and decision-making . 44 The role of memory in learning . 45 Short-term memory and learning . 46 Short-term memory: Seminal research . 46 Rote memorization & learning . 48 Memory & constructivist-based learning: Neuroscience evidence . 50 Brain structure & finite short-term memory . ..