Introduction
Critical thinking and reflective practice are critical features of effective learning in clinical contexts. The awareness of the internal and external factors that may influence clinical learning is important to ensure that one benefits from the practicum project. In addition, understanding adult learner characteristics, such as motivation, goal orientation, and experiential learning will help a nurse develop a new perspective on the clinical area (Lawal, Weaver, Bryan, & Lindo, 2016).
This essay analyzes how external/internal factors and the characteristics of the audience (nurses and nursing students) as well as those of the writer that may influence learning in an oncology unit. The clinical area considered is the development of a neurological assessment for patients receiving high-dose cytarabine (Szoch & Snow, 2015).
Characteristics and Factors Influencing my Motivation to Learn
External Factors
The three main external factors that may influence my motivation to learn include instructor characteristics, course design, and direct feedback. I find instructor behaviors such as personal appeal, interest in learners, articulation, and enthusiasm highly motivating in a classroom context. I also consider factors related to lesson/course format, including its organization, grading, and engagement as key learning motivators. Lastly, instructor feedback on my learning progress inspires my interest in the course.
Internal Factors
I derive intrinsic motivation from factors such as the fear of failure, personal challenge, and drive for excellence. Failing core courses leads to retakes, which I always strive to avoid. I consider new material/content a challenge or an opportunity to grow and become a critical thinker. I also have the intrinsic drive to excel in whatever I do, including in academics.
Personal Characteristics
The three personal characteristics that drive my motivation to learn to include a sense of achievement, self-esteem, and competence. I derive satisfaction from acquiring new professional skills and knowledge as it improves my practice outcomes. I also consider professional learning as a bridge to career growth and greater self-worth. I aspire to be a competent oncology nurse, a personal attribute that motivates me to acquire new skills, such as neurological assessment of patients under high-dose cytarabine.
Adult Learner Characteristics
One defining characteristic of adult learners is that they are self-directed and intrinsically motivated individuals (Daley & Torre, 2010). Nurses, as adult learners, are inclined to being self-reliant in their judgment and actions. However, job-related and familial responsibilities tend to limit this autonomy. Daley and Torre (2010) observe that individuals exhibit a high sense of responsibility early in adulthood, which can be seen in adult learning. Learning environments that demote adults to a passive position attract resistance and even sabotage.
This characteristic has particular implications for clinical teaching and engagement. In the present case, including the oncology nurses and nursing students as autonomous reflective practitioners would motivate them to learn the standardized neurological assessment. Self-directed learners evolve into critical thinkers with attributes such as open-mindedness, inquisitiveness, and problem-solving (Daley & Torre, 2010). Therefore, allowing the nurses some level of autonomy would motivate them to learn how to conduct Neuro checks and cerebral status assessments to reduce the risk of neurotoxicity in patients.
The second characteristic of adults is that they are experiential learners, i.e., their learning builds on past knowledge and life experiences. Nurses and nursing students, as adult learners, rely on their experiences when learning a clinical activity. Because the experiences vary between adult learners, a one-size-fits-all may not indicate a learner’s level of skill in a clinical area (Lawal et al., 2016). Bedside nurses are experienced in identifying neurological symptoms and implementing appropriate interventions. Therefore, by tapping into their experiences, the writer will be able to identify the essential aspects to consider in developing a standardized neurological assessment.
The nurses’ experiences constitute a crucial resource for learning better assessment practices. Adults, unlike children, harbor a “reservoir of life experiences” that they unconsciously relate to any new learning (Lawal et al., 2016, p. 35). Their perception of new concepts is rooted in their experiences and prior knowledge. This characteristic will be used to enhance motivation to learn the improved neurological assessment in two ways. First, the audience’s experiences will be sampled during the learning activity to enable them to connect the new concepts to existing knowledge. Second, a discussion about the learners’ experiences will be encouraged during the learning activity.
Adults also tend to be pragmatic and practical in their learning. They are motivated to learn concepts and skills with direct application to their “situation and needs” as opposed to theory (Lawal et al., 2016). The audience would want to learn practical skills in the evaluation of cerebral status and cerebellar activity. Thus, the learning activity will include a practical component, i.e., an actual neurological assessment in the oncology unit. The hands-on experience will enable nurses to recognize neurotoxicity and stop the cytarabine infusion.
The audience will need specific information that they can apply in their professional role. Das, Malick, and Khan (2008) suggest that adult courses contain utilitarian and integrated content to allow learners to apply the information in their work. Adults prefer practical skills that will improve their competence in their work. Thus, the learning activity must be relevant to the nurses’ individual needs and involve learning by doing. An adult’s desire to acquire workplace skills is driven by the need to improve one’s competence and mastery of a clinical area. Practical training of the audience on how to use an improved assessment protocol to identify neurotoxicity and stop cytarabine infusion has practical implications. Therefore, the practical aspect will be emphasized during this learning activity.
The fourth characteristic of adult learners is that they are goal-oriented. Adults are interested in knowing the purpose of a training program or initiative (Das et al., 2008). In other words, they develop expectations for what they will gain from learning activity. Failure to meet these expectations will demoralize them, leading to a high dropout rate. As goal-oriented learners, adults pursue activities that would enable them to meet individual/professional goals.
The purpose of the practicum project is to improve the outcomes of patients under high dose cytarabine through better neurological assessment. This goal will be communicated to the audience prior to the learning activity along with the expected outcomes. Through interactive engagement, the oncology nurses’ specific goals and expectations will be integrated into the learning activity. The instruction will be tailored to the needs and expectations of the audience to ensure that the assessment is as comprehensive as possible.
Internal Factors
The major internal factors that may influence the target audience’s learning are motivation and past knowledge. Coker (2003) writes that motivation influences “what people do, for how long and how well they do it” to achieve their academic goals (p. 657). Motivation is considered a fundamental principle of self-directed learning in adults. Intrinsic motivation is attributed to personal factors such as self-esteem, attitudes, and coping strategies (Coker, 2003).
The Expectancy Theory holds that the motivation to learn relies on two pillars: an expectation of a favorable outcome and prospects that the required performance is within one’s capability (Kim, 2012). Therefore, the audience may be motivated to learn a better neurological assessment for the timely detection of adverse effects of high dose cytarabine infusions if it meets their expectations. They may learn the skill if doing so will help them achieve higher satisfaction and gain confidence in the clinical assessment of neurological symptoms in cancer patients.
Individual knowledge is another internal factor that may influence learning in the present clinical scenario. Das et al. (2008) define knowledge as a subjective “background of facts and interactions between facts” that shape our understanding of new concepts (p. 498). The audience has pre-existing knowledge of neurological evaluations and documentation practices of an oncology unit. Therefore, the nurses and nursing students may achieve different levels of understanding of the subject due to varying knowledge levels and learning styles. However, through on-the-job training, the disparities could be addressed to ensure that nurses and nursing students benefit from the learning activity.
External Factors
The external factors that may influence learning in this clinical setting include incentives and organization of the content. Adults are goal-oriented learners. Although they are motivated and self-driven, knowledge of one’s improvement through feedback can be a good incentive. Das et al. (2008) state that an effective strategy for motivating adult learners is by “enhancing their reasons for learning” and eliminating the barriers (p. 495). Providing a warm learning environment that accommodates diverse learning styles may give the audience a reason to learn the improved neurological assessment. Regular feedback will reinforce their motivation to learn and adopt the skill in practice.
The organization of the learning material may also influence learning. The traditional classroom learning may not be effective for adult learners. Das et al. (2008) provide four principles of adult instruction, namely, evolutionary learning, enhanced participation, variety of instructional aides, and immediate applicability of the skills. The learning activity for the audience will be contextual and experiential as opposed to formal learning to improve retention. The learning material will contain theory and practice to appeal to the adult learners’ pragmatism and practicality.
Andragogy vs. Pedagogy
Andragogy is premised on self-directed learning while pedagogy is dependent on the teacher. Andragogy is based on five assumptions: self-concept, experience, readiness to learn, orientation to learn, and motivation to learn new material (Kim, 2012). While the learner’s experience is useful in andragogy (experiential learning), it is of no use in pedagogy, which is largely a didactic process. Since the present case involves an adult audience (nurses and nursing students), the andragogy theory is more relevant than the pedagogic model.
Experiential learners are critical thinkers and understand professional norms and practices. They engage in reflective practice to improve the quality of nursing care. Since the intervention seeks to improve neurological assessment of cancer patients under high cytarabine dosage, experiential learning is required.
Additionally, andragogy addresses the issue of intrinsic motivation, which is an essential characteristic of adult learners. Contextual learning can motivate adult learners to study because it allows them to relate the subject to individual experiences and prior knowledge. Therefore, the instructor plays a motivating role in adult learning. Besides, the learning activity should be relevant to medical practice. In the present case, the improved neurological assessment taught to the audience should be anchored in current practices/experiences in the oncology unit. Pedagogy emphasizes on a standardized curriculum, which does not suit the adult’s orientation to learning. Adults prefer learning organized around real-world applications as opposed to theory. Therefore, the appropriate theory in this case is andragogy.
Personal Characteristics and Factors
Personal characteristics may affect my interactions with the audience. One such characteristic is my learning style, i.e., the accommodator type. I prefer participatory and hands-on learning, which, in my view, enhances retention. While most adult learners in the audience prefer this approach to abstract conceptualization, young nurses with different learning styles may prefer a formal curriculum. In addition to individual characteristics, external factors, including hospital norms, institutional commitment, staff workloads, and concerns over adverse events may affect medical education on the improved neurological assessment. These external constraints may derail the implementation of an improved assessment protocol for detecting neurotoxicity in patients under high-dose cytarabine.
Conclusion
Adults are self-directed, intrinsically motivated, experiential learners. They also more pragmatic, practical, and goal-oriented than youthful learners are. Learning a better neurological assessment method for patients under high-dose cytarabine relates more to andragogy than pedagogy because the audience constitutes adult learners. Internal factors such as motivation and prior knowledge influence adult learning. On the other hand, external factors that affect adult learning include incentives and organization of the learning material. Knowledge of individual characteristics, such as learning style, is essential in clinical teaching and learning.
References
Coker, A. (2003). African American Female Adult Learners: Motivations, Challenges, and Coping Strategies. Journal of Black Studies, 33(5), 654-674.
Daley, B. & Torre, D. (2010). Concept Maps in Medical Education: An Analytical Literature Review. Medical Education, 44, 440–448.
Das, K., Malick, S. & Khan, K. (2008). Tips for Teaching Evidence-based Medicine in a Clinical Setting: Lessons from Adult Learning Theory. Journal of Royal Society of Medicine, 101(10), 493-500.
Kim, C. (2012). The Role of Affective and Motivational Factors in Designing Personalized Learning Environments. Educational Technology, Research, and Development, 60(4), 563-584.
Lawal, J., Weaver, S., Bryan, V. & Lindo, J. (2016). Factors that Influence the Clinical Learning Experience of Nursing Students at a Caribbean School of Nursing. Journal of Nursing Education and Practice, 6(4), 32-38.
Szoch, S. & Snow, K. (2015). Implementation and Evaluation of a High-Dose Cytarabine Neurologic Assessment Tool. Clinical Journal of Oncology Nursing, 19(3), 270-272.