http://jnep.sciedupress.com Journal of Nursing Education and Practice 2021, Vol. 11, No.

11

REVIEWS

Andragogy and teaching techniques to enhance adult

learners’ experience
Nicole Lewis1 , Venise Bryanú2
1
Western Regional School of Nursing, Corner Brook, NL, Canada
2
Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada

Received: May 18, 2021 Accepted: July 1, 2021 Online Published: July 14, 2021
DOI: 10.5430/jnep.v11n11p31 URL: https://doi.org/10.5430/jnep.v11n11p31

A BSTRACT
Nurse educators need to be cognizant of their instructional methods to ensure they are using appropriate techniques to effectively
teach students as adult learners. Andragogy is the practice of teaching adult learners; its role and application in concept-based
nursing education in the online, classroom, and clinical teaching contexts are explored in this reflective literature review. Concept-
based curriculum is a method of teaching that utilizes active learning strategies to aid in developing critical thinking skills and
knowledge comprehension. Reflections on incorporating andragogy to teach in a concept-based curriculum in nursing by a novice
educator is also presented along with selected teaching techniques that has been utilized to solidify nursing students learning.
It has been shown that non-traditional teaching techniques such as simulation, case studies, debates, and creating a “flipped”
classroom can be effective in applying andragogy in a concept-based curriculum model. Incorporating andragogy within the
concept-based curriculum is vital for equipping nursing students with necessary critical thinking and reflection skills required for
nursing practice.

Key Words: Andragogy, Digital learning environments, Concept-based curriculum, Nursing education, Personal reflection

1. I NTRODUCTION understanding what is being taught.[4] It is of utmost impor-

tance that nursing students are taught with various teaching
Nurse educators are responsible for teaching and preparing
methodologies, which will enhance critical thinking skills to
students for the workforce. They help ensure that nursing
provide outstanding patient care.
students acquire the necessary skills to provide safe, com-
petent, and compassionate care to patients.[1] Students need The purpose of this literature review and reflection is to ex-
to learn various strategies to engage in critical thinking and plore the role of andragogy (adult learning theory) in nursing
develop the ability to anticipate and recognize potential is- education and how it can be incorporated in teaching us-
sues they may encounter in practice.[1, 2] Traditional teaching ing a concept-based curriculum in the modern health care
methods such as lectures and PowerPoint presentations are environment. This paper discusses active learning and con-
passive, with little opportunity for students to engage in criti- structivism as adult learning theories in helping nurse ed-
cal thinking, thus, limiting students’ ability to provide safe ucators understand their role in teaching nursing students.
and effective patient care.[3] Instead, most students will use Concept-based curriculum is later discussed along with se-
memorization techniques to retain the information rather than lected innovative teaching techniques associated with active
ú Correspondence: Venise Bryan; Email: [email protected]; Address: Faculty of Health Disciplines, Athabasca University, 1 University Drive,

Athabasca, Alberta, T9S 3A3, Canada.

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learning and constructivism. Finally, we conclude with a was a main theme that was identified across the resources as
novice nurse educator’s personal reflection on teaching using being integral to adult learning and the implementation of a
a concept-based curriculum and innovative teaching tech- concept-based curriculum in nursing, hence a major focus of
niques to facilitate nursing students learning based on the the paper.[7] The final stage of an integrative literature review
principles of andragogy. is a presentation of the synthesis of the literature, which is
presented throughout in the upcoming sections, in addition
2. M ETHODS to the reflections of a novice nurse educator in implementing
An integrative literature review was undertaken according a concept-based curriculum rooted in andragogy.
to Whittemore and Knafl.[5] First, we identified the problem
where novice nurse educators need to become familiar with 4. D ISCUSSION
the theories that underpin the curriculum of their nursing 4.1 Andragogy
school and the best teaching techniques to use to support cur- Malcolm Knowles developed andragogy or adult learning
riculum implementation. The problem was further assessed theory which purports adults are self-directed and indepen-
by making it specific to the nursing school of the authors dent learners who take control of their own learning.[8] Adult
where concept-based curriculum underpin by andragogy is learners learn best when they are able to determine their own
being used. Next, we began our search of the literature goals for the course and take responsibility for learning.[9]
through a reflective analytical approach[6] to understand the Thus, andragogy emphasises learning through hands on meth-
role of andragogy and subsequently how it is incorporated ods that allow students to become engrossed and engaged in
in the concept-based curriculum model. A review of schol- activity. Educators who align with andragogy are cognizant
arly literature utilizing the Athabasca University Library, that learning experiences are unique to the individual, and
Memorial University Library, CINAHL, Google Scholar, that all students learn differently. As such, educators need to
and SAGE electronic databases was done. A general and collaborate with students to tailor teaching to learners’ needs
Boolean search of the literature were completed using multi- and identify appropriate learning strategies together.[9]
ple key terms including – “adult learning theories”, “active
Many learning theories have been developed based on the
learning”, “constructivism”, “teaching strategies”, with the
main principles of andragogy. Each theory incorporates dif-
inclusion criteria of “nursing education” and “concept-based
ferent teaching methods and strategies to ensure that the
curriculum”. We further refined the search to include “inno-
diverse needs of adult learners are being met. For this pa-
vative teaching techniques in adult education”. Innovative
per, we will primarily focus on the adult learning theories of
teaching techniques are frequently used teaching methods
active learning and constructivism.
that facilitate active student engagement.[1] The literature
data was then evaluated by reading abstracts to ensure rel- 4.2 Active learning
evance to the topic, and reference lists were scanned for Active learning is defined as the process by which students
subsequent articles. We also reviewed books on andragogy are effectively engaged in learning through various teaching
and the concept-based curriculum. techniques that facilitate a deeper understanding of course
material.[7] Research has shown that passive methodologies
3. L ITERATURE REVIEW RESULTS such as in class lectures are not effective in developing criti-
The search through the electronic databases identified 62 arti- cal thinking skills for students compared to active learning
cles of interest pertinent to the subject area. After evaluating methods.[3, 10] Active learning encourages faculty to engage
abstracts and the articles in entirety, 51 peer-reviewed arti- students through direct involvement, questions, and expe-
cles were deemed relevant and included a variety of methods riences.[11] When nurse educators utilize active learning
such as literature reviews and mixed method studies (see Fig- strategies, students exhibit engagement in completing inter-
ure 1). This was acceptable as integrative literature review active activities, which increases the morale of the classroom,
allows the flexibility to simultaneously include experimental improves students’ attitudes towards the course and educator,
and non-experimental research to fully understand the phe- creates a positive classroom atmosphere, and increases stu-
nomenon being explored.[5] A second full text read through dents’ self-confidence and clinical judgement skills.[7, 12, 13]
was completed on the 51 articles to discover pertinent infor- Active learning is crucial to the development of critical think-
mation related to andragogy, concept-based curriculum, and ing skills, communication techniques, problem-solving abili-
innovative teaching techniques. Finally, 41 peer-reviewed ties, and helps ensure students are well prepared for complex
articles were used that were most relevant. Active learning and challenging work environments.[14]

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Figure 1. Depicting literature search and the inclusion & exclusion criteria for articles

Comparatively, concerns regarding active learning are stu- Educators who apply constructivism believe learning is devel-
dents’ fear of the unknown as this is a shift from previous oped through reflection and relating value to experiences.[16]
known methods of learning.[7] Students may initially exhibit Learners are responsible and in control of developing their
negative reactions and anxiety at the prospect of deviating own knowledge.[14] Constructivism facilitates critical think-
from familiar teaching methods.[13] Learners may display ing, allowing learners to build on existing learning and create
feelings of uneasiness or bewilderment, which may lead to re- additional comprehension regarding previous experiences.[17]
sistance towards students’ receptiveness of active learning.[7] Utilizing this theory is essential to adult learners as it facili-
However, several prominent educators have incorporated tates critical thinking, which is more effective than simply
active learning in the classroom and have found students de- memorizing facts.
rived knowledge through making connections to previously
Constructivism has been criticized for minimizing the im-
known information, which is integral for adult learners.[9]
portance of the educator as the expert as control is shifted to
the students to become actively involved in their learning.[14]
4.3 Constructivism
Educators need to be proficient in providing students with
Constructivism learning theory purports individuals connect
the necessary skills and tools needed to become self-directed
new information and ideas to current and previously known
learners, which may be difficult for some educators who are
knowledge through interactive and engaging practices.[14, 15]
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more accustomed to traditional teaching methods.[14] As enhance learners’ interactions with peers and faculty.[22]
such, nursing schools need to incorporate faculty workshops
Fostering student engagement with online learning can be
to enhance understanding of this theory, so faculty mem-
difficult.[23] Some students find online learning to be distract-
bers feel supported and empowered by their organization to
ing at times due to other individuals residing in their home
successfully facilitate constructivism learning in practice.[18]
and could cause additional financial burden due to technol-
Despite the criticisms, the primary role of the nurse educator ogy needed for course participation.[22] Other challenges
utilizing adult learning theories such as constructivism is to noted in the literature were lack of communication and in-
provide effective teaching techniques online, in the class- teraction with peers that caused a sense of social isolation,
room, clinical, and skills laboratory, to enable the learner to poor internet connectivity, confusion with use of multiple
apply prior learning.[9, 14] Effective communication between virtual platforms, and difficulty in sustaining student engage-
the educator and nursing students is necessary to facilitate ment.[22, 23] Faculty also encountered challenges with main-
learning, as well as active interaction with peers.[14] Students’ taining academic integrity.[23] Due to the nature of online
interaction with peers throughout different experiences pro- learning, it can be difficult for faculty to maintain control
vides the opportunity to construct new knowledge.[9] over evaluation methodologies such as quizzes, exams, and
assignments.
4.4 Andragogy and the digital learning environment
Amidst the challenges of the digital learning environment
A digital learning environment is a multifaceted way of teach- the utilization of adult learning theories facilitates active
ing that is done utilizing technology and is usually online.[19] learning to foster critical thinking skills that are crucial for
The digital learning environment is connected to andragogy adaption to changing nursing practices. Thus, cultivating
and is a non-traditional method of educating individuals. In- individual growth and self-awareness among learners.[24] It
corporating active learning methods into an online learning is important for educators to provide learning activities that
environment is necessary to foster student interaction and allow students to reflect on what they know, identify personal
engagement.[7] Due to the current nature of the world with strengths and weaknesses, and promote self-assessment of
the COVID-19 pandemic, many higher education institu- their own learning.[25] Application of these learning theories
tions transitioned to online learning to avoid disruptions in are causing nurse educators to shift away from the traditional
the delivery of educational programs.[20, 21] Information dis- curriculum that has been used in the past, towards a more
semination is achieved using digital technology and virtual modern concept-based curriculum.
platforms. Online learning can be synchronous or asyn-
chronous, speaking to its adaptability in meeting the needs
4.5 Concept-based curriculum
of adult learners.[19, 21] Asynchronous learning can be com-
pleted at the convenience of the student and may incorporate Teaching nursing students is a complex task due to changing
pre-recordings, videos, reading material, or quizzes that are practices and health care environments. Nurse educators
uploaded online. Synchronous learning involves the use of need to implement clear teaching methodologies and models
live, interactive lectures with the instructor and students. to effectively teach students.[2] A concept-based curriculum
is a method of teaching derived from constructivism, that
Digital learning promotes the use of a student-centered, inter- facilitates learning by focusing on teaching students about
active learning environment.[22] It has the potential to illicit relevant concepts that are important for nursing practice,
a deeper level of learning and requires students to become including providing safe and competent nursing care to pa-
more self-directed.[20, 22] Online learning provides flexibility tients.[26, 27] According to Giddens, “concepts are considered
for students and increases accessibility of information.[20] It the building blocks or the foundation for theory” (p.x).[28]
enhances student autonomy and responsibility with learning Educators choose relevant concepts pertaining to nursing
and is an approach that is conducive to adult learners and practice and relate these concepts to facts and examples (also
multiple learning styles.[22] The literature highlights that called exemplars) that coincide with the concept.[5] Conse-
students and faculty appreciate the easy use of online web quently, students will gain a broad understanding of different
platforms for the delivery of course content, the convenience concepts, and are able to connect and relate their understand-
of accessing course content at a time appropriate for the ing to particular exemplars, as it is a continuous process of
student, the emphasis on being self-directed with learning, building on what the students already know.[28]
and the ability to re-watch recorded resources as it can en-
hance students’ understanding of material.[20, 22, 23] However, 4.5.1 Advantages
synchronous online learning should be incorporated with Concept-based teaching has the potential to increase class-
asynchronous deliveries to negate feelings of isolation and room engagement, inspire students, and positively impact
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clinical practice.[27] It is a student-centered approach to learn- students who are considered as adult learners. Innovation is
ing that fosters critical thinking and critical reflection which defined as “the act of constructive thinking, grouping knowl-
aids in preparing students for the workforce.[29] Students edge, skills, and attitude into new, original, and rational
learn about specific concepts related to clinical practice and ideas”.[1] Nurse educators must utilize teaching methods
learn to transfer knowledge to treat and understand a variety that are innovative to enrich the learning experience of adult
of health care conditions associated with each concept.[26] learners, thus empowering students to become engaged and
Teaching using concepts can promote lasting memorization self-directed in their learning.[1] This section discusses ex-
and understanding that students can utilize in their nursing amples of teaching techniques associated with adult learning
practice.[29] that have been used to achieve concept-based teaching in
nursing.
4.5.2 Disadvantages
Concept-based curriculum has its own challenges as it can 4.6.1 Simulation
be time consuming to help students build on concepts, they Simulation is a method of teaching that can be used to pro-
should have been taught from a previous course but may not vide opportunities to gain understanding of clinical compe-
remember. As such, many nurse educators are hesitant to tencies in a safe environment and enrich learning.[31] Simula-
implement concept-based learning in practice, stating the tion allows students to build on previously known knowledge
effects of this teaching methodology may negatively im- and attach value to experiences.[16] Different levels of sim-
pact students’ lifelong learning.[5, 29] Some educators have ulation may allow students to use various mannequins with
expressed feeling anxious about implementing curriculum different levels of technological functioning to simulate real-
change and deviating from a way of teaching that they are life clinical encounters.[31]
familiar with.[30] Other barriers to implementing concept-
Simulation has a positive influence on students’ communi-
based learning include lack of time to instil changes and
cation skills, confidence levels, and preparedness for clin-
feeling unsupported by healthcare institutions, thus, causing
ical encounters.[31] Simulation aids in students’ ability to
resistance and reluctance to modify curriculum to one that is
integrate, employ, and retain knowledge, and enhance per-
concept-based.[5, 29]
formance in the clinical setting.[32] Following the simulation
4.5.3 Use in practice scenario, students are provided with an opportunity for reflec-
Traditional teaching methods contain copious amounts of in- tion, referred to as debriefing.[16] It is during these debriefing
formation that often overwhelm nursing students, which can sessions that students critically reflect on the situation, en-
hinder development of critical thinking skills and cognition gage in discussion with peers and their nurse educator, and
of the information being taught.[3] Current healthcare envi- uncover what they feel went well in the situation, or what
ronments are increasing in complexity. Therefore, the nurs- they would change if they were to encounter a similar situ-
ing curriculum requires continuous enhancement to ensure ation. The process of engaging in reflection is vital to the
that students are being taught efficiently and with the neces- students as adult learners to build on concepts and relate
sary skills and knowledge required to succeed in this type them to personal experiences and values.[16]
of environment.[26] Using a concept-based curriculum can
Simulation also has several associated challenges. Cost,
promote opportunities for nursing students, as adult learn-
absence of support, lack of time and space, and shortage
ers, to expand knowledge and make connections to previ-
of proper equipment are the main barriers that have been
ously known information.[29, 30] The use of concepts permits
reported by educators.[12, 33] Although simulation requires
broader teaching, which allows educators to use it in a vari-
significant preparation of staff initially, it is an excellent
ety of settings, and students learn to relate concepts across
learning tool. Having several faculty members trained as
the lifespan of an individual, building on previously known
experts in simulation or designating a simulation coordinator
information.[30] Educators are expected to aid in facilitation
can aid in the amount of time spent preparing simulation
of learning through use of innovative activities suitable for
scenarios.[33] Nursing institutions can look for grant funding
adult learners to develop stronger, better prepared, and more
to obtain simulation equipment as well as seeking out refur-
knowledgeable nursing students.[14]
bished or donated materials such as beds, IV poles, and other
necessary equipment.[33]
4.6 Teaching techniques to enhance adult learners’ ex-
perience When supported and implemented appropriately, simulation
Teaching nursing using concepts allows educators to use in- is an effective teaching tool for students. It provides op-
novative teaching strategies such as simulation, case studies, portunities for educators to utilize interactive learning with
flipping the classroom, and debates to the benefit of nursing students.[18] Simulation has the potential to improve skill and
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knowledge development, reduction of errors, and increase become more active and self-directed in their learning, build
students’ confidence and self-awareness.[9] on and construct knowledge, and improve critical thinking
skills.[39] Nursing students need to have a higher level of
4.6.2 Case studies
cognition of the knowledge they are being taught to be suc-
According to Thomas and Schuessler case studies can reit-
cessful in the current health care environment and flipping
erate knowledge and information taught to students through
the classroom can help to achieve this.
readings and lectures and provides opportunities for stu-
dents to apply the knowledge to various scenarios.[34] Case Educators have reported that gradually introducing a
studies promote knowledge retention, critical thinking, and “flipped” classroom is crucial to successful implementation
heighten clinical decision-making.[35] Case studies con- of this teaching practice.[37] Taking the time to introduce
tribute to learning through use of real-life scenarios that this methodology and the change it will require for students
are easy and effective for educators to utilize in the class- will help nurse educators handle any resistance met from
room, and many are readily available in textbooks and online students.[38] Students may have initial feelings of anxiety or
faculty resources.[36] nervousness about a change in their learning environment
due to a shift from traditional methods. Thus, it is important
Educators can promote group collaboration through having
for nurse educators to provide reassurance, assistance, and
students work in small groups on a case study. The same case
demonstrate patience with students for this teaching strategy
study can be used throughout different courses, relating the
to be successful and effective.[38]
case study to different concepts that are being taught. Using
the same case study in multiple courses provides students the 4.6.4 Debates
opportunity to reflect, increase their knowledge, and build on Debating is a teaching strategy that generates dialogue
previously known information, that is congruent with adult amongst an individual and their peers. It fosters active en-
learning and the concept-based curriculum.[36] gagement and learning among students.[40] Debates are use-
A challenge associated with the use of case studies is lack ful in educating students about situations that can occur in
of engagement from students. Students may have difficulty practice that may challenge students’ ethics or morals.[40]
relating to the case study due to a lack of interest. It is im- Debates can also help change how an individual thinks about
portant that nurse educators select stimulating and appealing certain ideas or topics. Students are required to research a
case studies.[12] Unfolding case studies is a method that topic and develop a strong, clear, and concise argument about
nurse educators can use to enhance student engagement and their position.[1] This can lead to a transformation of precon-
participation.[36] This method begins with a simple case ceived notions or beliefs, especially if arguing a position that
study. Each week the teacher incorporates more information the student felt different about prior to partaking in the debate
into the initial case study, thereby building on knowledge scenario.[40] Debating contributes to development of critical
and different concepts as it coincides with what they are thinking skills, communication skills, and teamwork.[40]
learning in class. This strategy helps keep students involved While debate is recognized as an effective teaching technique,
with the case study throughout the semester and aids in con- debating can be a source of anxiety for students, especially
structing new knowledge and building on previously known if they are instructed to defend a position opposite to their
information.[36] beliefs.[41] In order for students to be successful in this activ-
4.6.3 “Flipping” the classroom ity, they must be willing to keep an open mind and engage
A “flipped” classroom methodology is a teaching strategy in the debate. In doing so, students can learn about varying
that has gained popularity in recent years. Using this tech- cultural and ethical perspectives, uncover new knowledge
nique, information that is typically taught in the classroom about different ideas and situations they were unaware of,
setting is assigned as pre-class work for students to com- and collaborate with classmates.[1, 40]
plete.[37] Active teaching techniques such as case studies,
role-play, patient scenarios, concept maps, mini lectures, and 4.7 Reflections of a novice educator on applying adult
group discussions are utilized in the classroom to enhance learning theories in a concept-based curriculum
and construct knowledge related to the pre-work.[37, 38] Of- model of learning
fering a pre-test or online quiz related to the pre-work can be The concept-based curriculum model of learning has been
an incentive for students to feel motivated to complete the recently adopted at the nursing institution where one of the
pre-work and helps educators with understanding specific authors teach. All first and second year instructional courses
areas of teaching that may need additional work in the class- of the undergraduate nursing program are taught using the
room.[38] The goal of a flipped classroom is to make students concept-based curriculum model. Being relatively new to
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teaching adults, the author has engaged in reflection on her opportunity to connect theory to practice.[35] This can lead
experience in teaching using a concept-based curriculum to modification and construction of knowledge, and develop-
approach. Based on the author’s reflection as a novice ed- ment of critical thinking skills.
ucator, she has come to realize the need to have a strong
Post-clinical conference is held for one hour after clinical
understanding of the adult learning theories that inform a
practicum. At the beginning of the session, the author pro-
concept-based curriculum, and how to successfully imple-
vides time for students to report about their clinical experi-
ment teaching techniques to facilitate active learning in her
ences and then use case studies to build on their encounters
teaching practice.
on the clinical unit. Case studies are a learning activity that
4.7.1 Use of simulation in practice can be used in various ways by educators, including devel-
The author has used simulations during laboratory and clin- oping reflective practice.[34, 35] Students have expressed that
ical instruction. A variety of simulation situations occur they find this beneficial as it allows time to decompress after
throughout the semester. High-fidelity and mid-fidelity sim- clinical encounters, organize their thoughts surrounding the
ulations that are 30-minutes in duration are done in the lab clinical day, and provides opportunity for them to critically
twice during the semester, as well as a full day high-fidelity reflect.
simulation at mid-term. Online virtual simulations have also Clinical groups are relatively small, so generation of dia-
been used to help the students to apply theory to practice. logue and group discussion often occurs after clinical. Due
The nurse educators develop different medical scenarios for to the COVID-19 pandemic the use of case studies during
each of these simulations and students are given details be- post conference became very beneficial as students were no
forehand to prepare. Students participate in the simulation longer allowed to meet in groups at the clinical setting to
in small groups when on campus and individually when discuss their clinical day and post conference was shifted on-
completing virtual simulations. Students are given the op- line. Additionally, at the start of the pandemic, students were
portunity to utilize nursing skills that they have previously not assigned to patients who tested positive for COVID-19
learned. During the simulation, students are monitored, and or were awaiting results. This limited the number of patients
a debriefing session occurs after to discuss how the students available for students to care for. Hence, the use of case
felt while completing the simulation. studies to scaffold students’ learning experience to build on
As the author conducted debriefing sessions, she has recog- their limited clinical experience that did not always involve
nised that students are able to converse as a group, reflect the care of patients with complex nursing needs. The author
on the scenario that just occurred, construct new knowledge engaged in conversation with students regarding any posi-
and ideas, and determine what they would do differently if tive or challenging situation they may have encountered that
they were to encounter this type of situation again. This day, which was very vital in completing clinical. She also
experience has caused the author to admit that simulation, utilized case studies to generate thought-provoking questions
particularly the time to debrief, is a valuable teaching strat- to keep the flow of conversation continuing amongst students
egy. Debriefing helps the nursing students as adult learners to as the case unfolded into discussing the care of more com-
actively engage in reflection and further build on what they plex patients. This provided opportunities for students to
already knew. Students have expressed positive feedback develop critical thinking skills and discover what they may
with both simulation and the debriefing session. They stated do differently if they were to encounter similar situations in
that it helped build connections between clinical scenarios the future. During post clinical conferences, the author also
and knowledge that they had learned during class and skills provided students with positive constructive feedback about
laboratory. Students also stated that it was beneficial in dis- their performance throughout the day to aid in building stu-
covering what actions they would do differently if they were dents’ self-confidence. Students have stated that they find the
to encounter the situation again during clinical practice. case studies and constructive feedback extremely beneficial
to their learning as it allows them to modify and build on
4.7.2 Use of case studies in practice their learning.
The author used the teaching technique of case study to
help students reflect and build on the concepts they know 4.7.3 Use of “flipping” the classroom in practice
by applying and adding new knowledge in post-clinical con- Recently, in the lab setting, the author and another educator
ferences. Applying nursing experience to case studies is an implemented a “flipped” classroom methodology to dissemi-
indispensable tool to utilize in practice that can enhance an in- nate information related to a content laden skills lab. Students
dividual’s self-awareness and supports life-long learning.[42] were given multiple readings to complete prior to attending
Case studies that encourage reflection provides students the the lab. During the session, students were divided into three
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groups of two students. Each group were given a different online setting. Many students stated that they enjoyed prepar-
topic and had to develop a small presentation to present to ing for the debate with their peers as it allowed them to learn
their classmates. Students were unaware that this would information about their classmates and understand course
be occurring prior to arriving at the skills laboratory, and it content better through discussing research information asso-
was their first experience with a flipped class. Majority of ciated with preparing for the debate. Students also expressed
the students expressed positive feedback and felt that it was positive feedback with watching classmates participate in a
beneficial for their learning. Students stated that completing debate during class. Many expressed that they felt it was ben-
the presentation improved their engagement with the class. eficial to their learning as it correlated with topics discussed
Students felt that if the educators were to disseminate all throughout the semester.
this content, they would have lost focus and would not have
Upon reflection, the author has concluded that novice edu-
retained as much information. A small number of students
cators need to develop a deep understanding of the theories
expressed a strong dislike for this teaching strategy as it pro-
that inform their teaching practice. Coming to understand
voked feelings of anxiety and stress related to presenting the
the underpinnings of andragogy, active learning, and con-
information in front of their classmates. These students felt
structivism, has enhanced the author’s teaching practice and
that increased exposure to the flipped classroom methodol-
inform her approach to teaching nursing students as adult
ogy would help them to overcome their anxiety associated
learners. Hence, the author has been purposeful to utilize
with this teaching strategy.
teaching strategies that will foster active learning for adult
Due to the COVID-19 pandemic, the mode of teaching learners as she implements a concept-based curriculum in
shifted from in-person to online. It became imperative to nursing. Utilising teaching strategies that promote engage-
provide teaching that is engaging for students in an online ment and active participation, allows for simultaneous use
setting,[19] as such, the flipped classroom technique was used with online, lab, classroom, and clinical practicum learning
to facilitate engagement. The flipped classroom technique activities. For example, being able to start with a simulation
was used where students were presented with resources to scenario, then using a case study based on the simulated
review such as videos, readings, and/or Power Point presenta- scenario and finishing with a debriefing session can facili-
tions prior to attending an online synchronous class. During tate group discussion, reflection, and continuity of learning.
the synchronous online class, active learning was facilitated According to West, learning is improved when students are
as students were assigned to lead group discussions with engaged in an assortment of learning activities.[45] Likewise,
their instructor and peers based on the revision of resources students have expressed to the author that their learning is
they were given prior to the class. Use of this methodology enhanced by using a variety of active learning strategies
is shown to enhance construction of new knowledge and that provides opportunity to build on prior knowledge and
promotes self-directed learning.[21] Students expressed posi- construct new knowledge.
tivity with this method as it allowed for increased interaction
and engagement with their peers. 4.8 Future research plans
4.7.4 Use of debate in practice Further research in the area is warranted and could explore
Online debating was utilized in one of the author’s theory the usefulness of incorporating innovative teaching strategies
courses as part of the evaluation methodology. A total of nine that align with adult learning theories and concept-based cur-
debates took place over the course of the semester. Students riculum model in various teaching and learning settings. For
were paired into groups of seven students; one individual example, qualitative research or mixed methods study could
being assigned the role of the moderator, and three individ- be done to monitor the effectiveness of innovative teaching
uals being assigned to a pro side, and to the con side of strategies with clinical groups. This will aid in building a
the debate. The debates took place synchronously during foundation of knowledge surrounding students’ thoughts and
designated class time and were approximately 20 minutes feelings regarding these teaching techniques and how they
in length. The use of debates in an online learning environ- contribute to students’ success and transition. Stakeholders
ment aid in enhancing student interactions with their peers and nursing education leaders may also find it beneficial to
and course instructor.[43] Collaboration amongst students develop an information session pertaining to andragogy, ac-
when completing work in an online environment is benefi- tive learning, concept-based curriculum, and the associated
cial for helping students develop enhanced knowledge of the teaching techniques, and incorporate it into orientation for
class content.[44] Students expressed feelings of anxiousness newly hired nursing educators. Use of this curriculum can
initially with this assignment, as they were nervous about be overwhelming and having an information session may
appearing on camera and speaking to their classmates in an help to decrease feelings of anxiousness and provide sup-
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http://jnep.sciedupress.com Journal of Nursing Education and Practice 2021, Vol. 11, No. 11

port for newly hired nurse educators. The usefulness of the learning, foster critical thinking skills, and develop a higher
information session during orientation could be evaluated level of cognition in nursing students.
by collecting quantitative and qualitative data from novice
Nursing students who develop the fundamental skills that
educators who attend the orientation sessions.
are needed for today’s complex health care environment will
be more successful in providing exceptional care to their
5. C ONCLUSION patients, and this is best facilitated by educators who value
A reflective approach guided this literature review that has adults as learners by using active learning teaching tech-
shown how concept-based curriculum model is an effective niques. This reflective literature review adds to the literature
means of applying adult learning theories to facilitate active by showcasing the importance and application of andragogy
learning and help nursing students learn and develop critical to guide a concept-based curriculum. The reflective accounts
thinking skills. In healthcare today, nurses are expected to of a novice educator have been presented to possibly bene-
provide safe, competent, and ethical care to their patients. fit early-career nursing educators’ practice to arm nursing
Use of active teaching methods by nurse educators is a bene- students with necessary critical thinking and reflection skills
ficial instructional process that aids in effectively preparing required for safe, competent, and ethical nursing care.
students for the workforce. It is imperative that nursing edu-
cators move towards utilizing teaching techniques in align- C ONFLICTS OF I NTEREST D ISCLOSURE
ment with adult learning theories to promote self-directed The authors declare that there is no conflict of interest.

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