Adult learning paper receives TNF Scholarly Writing Award: making a case for Andragogical approaches to Teaching and Mentoring Students.

Introduction

Changes in the insurance industry have altered the healthcare business tremendously. Lack of insurance and financial constraints compounded by the nursing shortage will likely influence quality of healthcare, access to healthcare, and health seeking behaviors of individuals who are ill. Patients who are less likely to participate in preventive health promotion behavior are often more acutely ill when entering healthcare systems, further increasing the need for highly skilled nurses. These changes make critical thinking skills even more crucial to nurses who are providing care. The estimated demand for nurses with the skills to function in changing healthcare systems precipitated the need for changes in academia to increase the number of nursing students entering and graduating from nursing schools. Universities developed accelerated BSN programs for students with degrees in other fields (Bentley, 2006). These programs attract a different kind of learner than those taught in early nursing programs. These students are older, more mature, highly motivated and possess a greater sense of confidence (Ouellett & MacIntosh, 2007; Roberts, Mason, & Wood, 2001; Utley-Smith, Phillips & Turner, 2007). The learning styles for these students are typically different from traditional nursing students who enter nursing school from high school; consequently, teaching methods are needed to match the learning styles of these students.

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Researchers report that other differences exist in experiences of accelerated BSN students when compared to traditional students. Students report that even though accelerated programs best suit their needs because of the shorter length of time till program completion they report higher stress levels when compared to students from traditional programs (Ouellet, MacIntosh, Gibson, & Jefferson, 2008; Roberts, Mason, & Wood, 2001; Meyer, Hoover, & Maposa, 2006; Youssef & Goodrich, 1996). In this article, pedagogical and andragogical teaching and learning approaches are discussed. The andragogical approach to educating nursing students enrolled in accelerated programs is introduced in this paper as one approach for reducing students' stress and enhancing critical thinking skills. Examples of andragogical interactions with students used by the author and students' responses to this approach will be discussed.

Pedagogical Approach to Teaching and Learning

To fully understand the andragogy model of teaching and learning, one must first understand the pedagogical model which is the conventional approach to teaching and learning. The pedagogy learning model is the method that has historically dominated educational strategies for many years. Pedagogy is the traditional approach to teaching. Within this model the teacher is the dominant authoritarian and expert in the teaching learning process. In this model, learning is teacher driven and motivation by the students to learn is externally driven by grades or rewards from significant others. The relationship between the teacher and student fosters dependency--there is an unequal, vertical power distribution inherent in this relationship (Bedi, 2004; Blondy, 2007; Quirk, 1994; Knowles, 1984; Milligan, 1997). Teachers who use the pedagogy method of instructions use styles that are assertive and or suggestive. With the assertive style the instructor gives directions, asks questions, and gives information. In the suggestive style of teaching the teacher suggests alternatives, offers opinions, and relates personal experiences (Benzi, 1998; Quirk, 1994; Langlois & Thach, 2001). Both styles are clearly teacher-centered facilitating student submissiveness within the learning experience.

Andralogical Approach to Teaching and Learning

The andragogical approach, developed by Malcolm Knowles as an adult learning approach to education, is student-centered. Within the model there is a collaborative relationship between the student and teacher. The power distribution within the student-learner relationship is horizontal. Andragogical methods advocate for an environment that encourages student independence, enhances self-esteem, and increases critical thinking (Blondy, 2007; Milligan, 1997). The role of the teacher in this model is facilitator and coach. The teaching behaviors that correlate with principles of student-centered learning are the facilitative and collaborative teaching styles. Collaborative teaching style occurs when the teacher elicits and accepts learner ideas and empathizes with students. The facilitative approach elicits and accepts learner's feelings, offers feelings, encourages the student, and uses silence. These teaching strategies are more effective for fostering independence and a positive learning environment. Knowles' philosophy related to andragogy methods of teaching and learning was greatly influenced by Carl Rodgers theories on interpersonal relationship in the facilitation of learning (Blondy, 2007; Smith 2002). In Rodgers theory, qualities of the interpersonal relationship that facilitated learning were identified. The first quality that is needed is realness to facilitate learning. This component proposes that an instructor who is genuine is more effective than an instructor who is presenting a facade. Secondly, prizing, acceptance, and trust are qualities of teachers who successfully facilitate learning. These qualities include valuing self, caring for the students, and accepting the students where they are in the learning process. The last quality identified by Rodgers is empathic understanding--the teacher makes an effort to understand the student (Smith, 2004). Rodgers' theory of interpersonal relationship compliments andragogical teaching and learning approaches. The principles are student-centered, relationship-oriented, and collaborative in nature and are deemed more effective with regard to facilitating learning, reducing stress, and enhancing critical thinking in adult learners.

Andragogical Approach and Student Stress

Research has shown that students in an accelerated BSN nursing program report that the work is very stressful and demanding (Meyer, Hoover, & Maposa, 2006). Student identified sources of stress include strained relationships with teachers and faculty response to students (Jones & Johnston, 1997; Timmins & Kaliszer, 2002). Students participating in a phenomenological study reported that having sensitive and perceptive faculty members helped them succeed in the nursing program (Cangelosi, 2007). Andragogical approaches encourage empathetic interactions, self-directedness, and independence in students. In this type of environment students more often feel that they have control. Rogers believed that when students feel threatened they become more inflexible but when relaxed students become completely free to explore information and incorporate theoretical knowledge into clinical or life experiences (Smith, 2004). These approaches also role model team building behavior that is desperately needed in nursing today. This paper argues for combining andragogical approaches and principles from Carl Rogers's interpersonal relationship theory as a solution for educating nurses for 21st century practice and retaining nurses in the profession.

Andragogical Approach and Critical Thinking

Critical thinking is a crucial skill that is needed by nurses to meet the challenges of an evolving health care system and demands of patient care needs of the 21st century. Teaching critical thinking is a crucial component of nursing curriculums and novice skills in this area are a necessary student outcome for effective nursing care delivery. Nursing schools use a variety of programs to assist students to develop critical thinking skills such as problem based learning (Cirocco, 2006; Giddens & Duphorne, 2007). Findings in research studies failed to provide supportive evidence that the problem based learning interventions were effective in increasing the student's critical thinking skills (Worrell, Profetto-McGrath, 2007; Yaun, Williams & Fan, 2008). Findings from research studies suggest that teachers found it difficult to implement critical thinking skills programs because the traditional learning environment would have to be modified, students were resistant to innovative strategies, and time constraints (Shell, 2001; Hannafin & Savenye, 1993; Onosko, 1991). A critical thinker is inquisitive, knowledgeable, reflective, flexible, and prudent in using clinical reasoning (Facione & Facione, 1996; Khosravani, Manoocherhri & Memarian, 2005). The andragogical approach enhances the student's ability to use critical thinking. This approach advocates for collaborative and facilitative styles of teaching which encourage and assist students to formulate and explore feelings related to concepts. Great critical thinkers are inquisitive, honest in facing biases, willing to reconsider, and focused on inquiry (Facione, 1990; Facione & Facione, 1996). These skills are needed to confront the complex nursing problems of the 21st century. Concepts from Knowles andragogy model advocates for self-diagnosis and reflection on learner problems. The role of the teacher using the andragogy method is to facilitate this type of environment where students can think, feel, problem solve, and reflect.

Andragogical Interactions

The andragogical approach to teaching and learning form the basis for my interactions with students. In the classroom when students ask questions and discuss concerns about the class, eye contact, listening skills, and therapeutic communication were used. Empathy was demonstrated when interacting with students expressing concerns about failing grades, overwhelming course work and family problems even though the policies were reinforced. Students were encouraged to develop solutions to their problems in a nonjudgmental manner. Therapeutic communication skills were applied and role modeled in the clinical area with patients and staff. Students were able to see this style of interaction when problem-solving and resolving conflict. Modeling this behavior is crucial to encourage appropriate conflict resolution and cooperative styles of interacting that could be used in their future work place. Students were able to problem solve in the clinical area independently, interact professionally with staff on the unit and assist in identifying new ways to provide care for patients.

Feedback from Students

I was awarded the Excellence in Teaching Award because students believed that as an instructor I made a difference in their learning experiences. This award came with a monetary incentive. Some of the students' statements were "Thank you for helping me confront my fears," "she is very approachable," "very kind," "helpful and very kind," and "thanks for making this a pleasurable experience." I received these compliments from students that I taught here in the continental U.S.A as well as students taught in the Virgin Islands and with BSN and Associate degree students. Acceptance and valuing of this approach by students suggests that this approach is relevant and effective across institutions and student populations.

Conclusion

Andragogical approaches to teaching and learning are crucial for creating an environment that fosters students' critical thinking skills and allows the teacher to role model effective communication skills and team building behaviors to this new generation of students in nursing programs today.

* References are available by contacting the Tennessee Nurses Association at [e-mail].

by Lois Bolden, PhD, PMHCNS-BC SAMHSA Post Doctoral Fellow