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Staff development is an important role of the school nurse, yet little is written to assist the nurse in this role. Though some obtain advanced degrees in education, most school nurses are not prepared for the staff development role without further education in pedagogy, teaching strategies, and evaluation methods. This article presents discussion as one of many active teaching strategies that can engage learners and promote critical thinking. More work is needed in the area of course design and implementation, as well as additional research to help identify the most effective teaching strategies for school employees.

Keywords: staff development; in-service training; discussion; adult learning; school nurse role; lesson plans

Over the past decade, schools have been increasingly mandated to provide training for staff members

on topics such as relief of foreign body airway obstruction, blood-borne pathogens, and child abuse recognition and reporting. Additionally, childcare staff in Ohio are required to receive training in communicable diseases, first aid, and cardiopulmonary resuscitation as part of a required (or “totaling”) 15 hours of staff development training each year (Ohio Department of Education,

2009). School nurses are increasingly called upon to present this content, and NASN standards of practice support this teaching role (American Nurses Association, 2011).

Though some school nurses obtain advanced degrees in education, they are not usually prepared for the staff development role without further education in pedagogy, teaching strategies, and evaluation methods. Many rely on PowerPoint presentations in lecture format instead of using more engaging teaching strategies. Learning principles of curriculum and course development are a starting point to developing the teacher role of the school nurse. Choosing an effective teaching strategy is a second important aspect of course development. The purpose of this article is to discuss considerations for teaching adults and explore discussion as an effective strategy that will stimulate active learning while engaging faculty and staff in the process of critical thinking.

Though health education is frequently cited within the scope of school nursing practice, it is most often in the context of the individual and classroom teaching of students or as a resource for classroom teachers, including providing input into curriculum development (Broussard, 2004). Proctor (2006) and

McHenry, Silver, and Wolfe (2006) described faculty and in-service education as a part of the health teaching and health promotion standard of practice for school nurses.

Adult Learning

With in-service programs being focused on faculty and staff, it is important to realize the difference between learning styles of children and adults. School nurses proficient in classroom instruction with students will need to consider the unique needs of adult learners. There are several theories about how adults learn, as well as different domains of knowledge. Review of adult learning theory is beyond the scope of this article, though Mintor (2011) summarized some important assumptions regarding the teaching of adults. He pointed out that the adult learner brings a wealth of experience to the learning environment, along with a self-directed focus. Adults prefer to be actively engaged in learning and prefer a facilitator who is learner focused. They have a great foundation on which to build new information for their own use. Additionally, it is important to consider the many ways that adults learn. Various dynamics influence learning, including motivational factors, learning styles, amount and type of professional

Talking Out Loud in ClassUtilizing Discussion as an Effective Teaching Strategy With Adult LearnersAmy L. Hotler, MSN, RN

DOI: 10.1177/1942602X13488630For reprints and permission queries visit SAGE’s Web site, http://www.sagepub.com/journalsPermissions.nav. 2013 The Author(s)

Feature Article

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experience, educational preparation for their role, and the context of learning (e.g., required vs. elective) (Sherwin, 2010; Wellman, 2009). Using a variety of teaching strategies (in addition to presentation style) is most likely to support the various dynamics and multiple learning styles of adults (Bain, 2004; Gross Davis, 2009; McKeachie & Svinicki, 2011).

Bloom’s taxonomy is a way of identifying and classifying various domains of learning and cognitive levels. Benjamin Bloom is credited with this classification system, created in 1956 and revised in 2001 (Erickson, Peters, & Strommer, 2006). The taxonomy describes cognitive, behavioral, and affective domains. In the cognitive domain, the learner is concerned with concepts including understanding, reasoning, and application of information. The behavioral domain is related to learning specific physical tasks or motor skills. Finally, the affective domain is concerned with developing values (McDonald, 2007; Onega & Devers Barbero, 2010). For example, in a staff in-service about removal of a foreign object from an airway, an instructor would want to address the behavioral domain of teaching, which would encompass the motor skills necessary to perform abdominal thrusts on a choking victim. The cognitive domain might be addressed in a communicable disease presentation through helping learners develop a prevention strategy by assimilating what they have learned about the spread of disease using a chain of infection model. In a child abuse prevention course, learners may be impacted in the affective domain by learning to view perpetrators of violence as individuals with poor coping skills and a lack of support systems, two characteristics associated with those who abuse (Ohio Department of Jobs and Family Services, 2007). This could have far-reaching consequences by inspiring participants to create an environment of family support, which could result in the prevention of abuse.

Further, all three domains might be utilized for a single subject. Utilizing the removal of a foreign body from an

airway example given above, the cognitive and affective domains can be secondary focuses. The instructor can use the cognitive domain to help the learner understand why abdominal thrusts are effective. The affective domain is utilized when the instructor reminds students that in a choking episode, the victim is typically embarrassed and often seeks to retreat to a restroom or other place out of site of the remaining individuals. Helping the adult learners relate to the past embarrassment they have felt while choking has the possibility of strengthening the effectiveness of the instruction, namely, to never let a choking victim go off by themselves.

In regard to effective teaching strategies, there are many that are appropriate for adult learners. Some examples include problem-based learning, where a group works toward the solution of a case study over a matter of time, utilizing role plays, electronic communication strategies, or multimedia, to name a few (Bradshaw & Lowenstein, 2011). Discussion is one teaching strategy that has been found to be particularly effective with adults. Therefore, this strategy will be explored for the remainder of the article.

Discussion Method

Discussion facilitates the adult learner’s ability to use past experiences to build new knowledge. Brookfield and Preskill (2005) identified many benefits of discussion, including helping learners develop a tolerance for ambiguity and diversity, as well as foster critical thinking skills. The authors pointed out the benefit of encouraging good listening skills and improving collaborative learning. They also asserted that discussion helps students scrutinize their assumptions by testing them out in small group settings. This process, according to the authors, “increases intellectual agility” (p. 22).

Further, discussion requires a certain amount of exposure to the topic at hand. Ezzedeen (2008) asserted that “prior preparation boosts students’ confidence and fosters a greater desire

to participate” (p. 233). Because pre-reading isn’t always possible prior to in-service programs, it’s important to plan how to provide some background information before the opening of a discussion. This could be in the form of a short reading assignment on the day of the meeting or the presentation of a short video clip. It might also be effective to invite those in the group with experience to share their knowledge or expertise, enriching the knowledge base of the group.

When choosing discussion as a teaching strategy, planning for seating is especially important. Arranging the room in a circle or, for larger groups, a horseshoe can eliminate obstacles such as desks and other participants by creating a seating arrangement where all participants can see one another (Edmunds & Brown, 2010; Ezzedeen, 2008). Arranging the space so that the facilitator is not at the perceived front of the classroom will encourage participants to talk with one another rather than dialoguing with the instructor (Gross Davis, 2009).

Discussion is more productive and effective if ground rules are established at the beginning. According to Landis (2011), “when people feel safe, listened to and understood, their performance is enhanced” (p. 88). Ground rules establish an atmosphere where participants are respected (Brookfield & Preskill, 2005; McCann, Johannessen, Kahn, & Flanagan, 2006). Bain (2004) added that an environment where learners can try, fail, and learn by their mistakes adds to a learner’s sense of safety. Participants can assist with the development of ground rules at the beginning of the in-service, and these can be written on a dry erase board or newsprint for ease of reference throughout the program.

Getting a discussion started can be challenging for several reasons. Sometimes participants have developed passive learning habits from past lecture-style presentations. Others may fear criticism, believing that the facilitator is looking for a specific answer (McKeachie & Svinicki, 2011). Still others may avoid

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participating in discussions for cultural reasons (Gross Davis, 2009). As shown in Table 1, these obstacles can be minimized by talking with staff about the method of instruction, detailing the value of discussion, creating ground rules, and giving tips for participating in discussion (Erickson et al., 2006; Gross Davis, 2009). Facilitators can model good listening techniques, keeping an open mind and giving encouragement to others. This creates a safe environment, conducive to effective and meaningful discussion.

There are various creative grouping ideas that can keep a discussion lively and learners engaged. Though this is not an exhaustive list, several will be discussed here. Brookfield and Preskill (2005) presented many of the techniques, including snowballing (also known as pyramid), jigsaws or crossover groups, buzz groups, and newsprint dialogue.

In snowballing or pyramid, a question is posed to pairs of participants and they begin by exploring the given topic. After a designated period of time, the pair is combined with a second pair to make a group of four and the discussion continues, combining the points of view of each twosome. The process continues in the same manner, doubling the group every few minutes. Edmunds and Brown (2010) suggested that beyond groups of four, a facilitator should add more challenge to the topic to avoid boredom. Gross Davis (2009) added an interesting twist by increasing the complexity of tasks at each group doubling. “For example, during the first round, group members share their ideas, during the second round, the larger groups identify common patterns among the ideas, and during the third round, the still-larger groups develop guidelines, principles, or action plans” (p. 208).

Jigsaws, also known as crossover groups, are useful in topics with many different subthemes. In the first round, group members are formed that explore one of the many aspects of the topic. In a subsequent round, group members are reconfigured so that one member from each subgroup becomes the expert on

the topic of the first round. The experts then share what they gleaned from round one. This technique is a quick way for group members to learn many different facets of a problem in a short amount of time. For instance, in a class on the topic of child abuse prevention and recognition, three groups would explore the characteristics of abusers, characteristics of the abused, and physical signs of child abuse, respectively. Subsequently, the participants are regrouped so that there is one expert from each subgroup. Each topic expert takes a turn leading the discussion, sharing key concepts with the rest of the group. When the process concludes, all members are experts on each of the distinct topics.

Buzz groups can be relaxed or structured. In relaxed buzz groups, small groups come together to discuss a topic. There are no particular questions to be answered or concepts to be explored. The only requirement is that members remain focused on the topic at hand.

Relaxed buzz groups could be suitable ice breakers and a great way to introduce a topic for discussion. Because the requirements are limited, there is no pressure in the dialogue. Those who are less prepared can still be a part of the conversation and competition is limited. According to Edmunds and Brown (2010), the facilitator is not usually involved in the brief discussions of the buzz group.

Structured buzz groups are given an agenda to follow and are expected to come up with answers to specific questions. Brookfield and Preskill (2005) suggested allowing some flexibility and choice in answering questions so that spontaneous exploration of the topic can still take place. This way, if the group wants to explore a compelling facet of the topic, freedom allows them to stray from the suggested direction proposed by the given agenda. The authors also suggested maintaining group sizes of four to five participants so that discussion is more manageable.

Increase Participation Keep the Discussion Going

Get to know the participants Use nonverbal cues (nodding, smiling, eye contact)

Create a safe environment through establishment of ground rules

Draw students in: “Do you agree or disagree?”

Arrange seating to promote discussion: All participants face one another

Encourage shy students

Spark discussion with a video clip, controversy, anecdote, etc.

Discourage monopolizers: Thank them and ask for others to add to their comments

Vary the facilitator’s position away from the perceived front of the classroom to avoid the single dialogue with facilitator

Tactfully correct wrong answers

Periodically arrange participants in smaller groups

Ask open ended questions

Allow periods of silence to create clarity among participants

Ask questions with many possible answers

Do not answer your own questions Ask general questions with no wrong answer: “How do you feel about this?”

Model active listening and courteous communication

Limit facilitator comments

Creative grouping: snowball, jigsaw, buzz groups, etc.

Mediate differences

Table 1. Tips for Facilitating Discussion

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Brookfield and Preskill (2005) also described a technique for reporting discussions back to larger groups, where a group summarizes discussion results on newsprint or a chalk board. Once the group discussion is recorded, individuals can stroll about, looking at the responses of other groups and comparing them to their own group’s perspective. Participants are encouraged to look for themes and contradictions that can spur continued discussion. The authors included a variation on this technique, where group members rotate to the next newsprint and continue their discussion based on remarks made by the previous group. Rotations continue until each group has had a chance to respond to each set of written responses.

Conclusion

Though responsibilities for staff training are increasing, not much is written addressing the role of the school nurse in staff development. This article has highlighted important considerations when planning for adult learning, suggesting discussion as an effective teaching strategy to support active learning and engagement of faculty and staff. Several challenges of the discussion technique have been presented, including strategies to overcome or limit these obstacles.

The educator role of the school nurse is varied and expansive. Effective teaching strategies for staff are only one piece of the puzzle. More work is needed in the area of course design and implementation. Research would help identify the most effective teaching strategies to employ with staff members. By following a systematic plan of course development, school nurses can provide high quality faculty and staff education, making an important contribution to quality schools. ■

Acknowledgments

The author wishes to thank Heather Janiszewski Goodin, PhD, RN, for her

support, encouragement, and contagious enthusiasm, as well as thoughtful review of earlier drafts of this work.

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Amy L. Hotler, MSN, RNSchool NurseColumbus City SchoolsColumbus, OHAmy is a school nurse, serving the pre-kindergarten children and families of the Columbus City School District in Columbus, Ohio. She also provides staff development opportunities in the district for the Department of Early Childhood Education.

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