Anurag Bhai Patidar

Communication and Nursing
Education
Anurag Bhai Patidar

College of Nursing
Dayanand Medical College & Hospital
Ludhiana, Punjab
Frontmatter.indd 1 6/2/2012 9:47:35 AM

Copyright © 2013 Dorling Kindersley (India) Pvt. Ltd
Licensees of Pearson Education in South Asia
No part of this eBook may be used or reproduced in any manner whatsoever without the publisher’s prior
written consent.
This eBook may or may not include all assets that were part of the print version. The publisher reserves the
right to remove any material present in this eBook at any time.
ISBN 9788131788394
eISBN 9788131799581
Head Office: A-8(A), Sector 62, Knowledge Boulevard, 7th Floor, NOIDA 201 309, India
Registered Office: 11 Local Shopping Centre, Panchsheel Park, New Delhi 110 017, India

To my Grandparents
Heera Lal and Geeta
who have taught me everything.
They are a source of great inspiration and encouragement for me.
Without their blessing and unconditional Anurag (Love),
this Endeavour will not have been possible.

This page is intentionally left blank.

Contents
Foreword xiii
Preface xv
CHAPTER 1 REVIEW OF COMMUNICATION PROCESS 1

1. Introduction 1
2. Definition 2
3. Process, Elements, and Channels of Communication 3
4. Types of Communication 4
5. Levels of Communication 7
6. Factors Influencing Communication 10
7. Barriers of Communication 12
8. Methods of Overcoming Barriers of Communication or Facilitating
Communication 15
9. Techniques of Effective Communication 18
Chapter Highlights 22
Evaluate Yourself 22
References/Further Readings 23
CHAPTER 2 INTERPERSONAL RELATIONSHIP 24

1. Introduction 24
2. Interpersonal Relationship 24
3. Types of Interpersonal Relations 25
4. Phases of Interpersonal Relationship 27
5. Barriers in Interpersonal Relationship 28
6. How to Overcome Barriers in Interpersonal Relationship? 31
7. Johari Window 32
8. Principles of Change in the Size of Quadrant within the Johari
Window 35
9. Limitations of the Johari Window 35
10. Harry Stack Sullivan Interpersonal Relations Theory 35

vi | Contents
CHAPTER 3 HUMAN RELATIONS 38

1. Introduction 38
2. Human Relation 38
3. Understanding Self 39
4. Social Behavior 40
5. Theories of Motivation 44
6. Social Attitude 46
7. Individual and Group 48
8. Group Dynamics 50
9. Teamwork 52
10. Human Relations in the Context of Nursing 53
CHAPTER 4 INTRODUCTION TO EDUCATION 57

1. Introduction 57
2. Definition and Meaning of Education 57
3. Aims of Education 58
4. Purposes and Functions of Education 60
5. History and Trends in Development of Nursing and Nursing
Education in India 61
6. Changing Trends, Impact of Socioeconomical, Political,
Technological Changes on Nursing Education 63
7. Types of Education 65
8. Distance Education 65
9. Philosophy of Education 67
CHAPTER 5 TEACHING–LEARNING PROCESS 81

1. Introduction 81
2. Defining Teaching 81
3. Concept of Teaching 82
4. Principles of Teaching used in Nursing Education 83
5. Maxims of Teaching 85
6. Concept of Learning 87
7. Nature of the Learning: Learning Theories 88
8. Characteristics of the Learning 89
9. Types of Learning 90
10. Learning Styles 91

Contents | vii
11. Relationship between Teaching and Learning 94

12. Educational Aims and Objectives 94
13. Purposes of Educational Objectives 94
14. Types of Educational Objectives 95
15. Qualities of Educational Objectives 96
16. Characteristics of Specific Objective 96
17. Classification of Domains of Learning Objectives 96
18. Elements or Components of the Specific Learning Objectives 97
19. Writings of Educational Objectives 98
20. Competency-Based Education (CBE) 99
21. Objective-Based Education (OBE) 100
22. Instructional Design: Need and Importance of the Lesson Plan 101
CHAPTER 6 CLASSROOM MANAGEMENT 110

1. Introduction 110
2. Purposes of Classroom Management 111
3. Principles of Classroom Management 111
4. Domains of Classroom Management 112
5. Classroom Management Strategies 112
6. Behavior Modification Strategies 116
7. Common Mistakes In Classroom Management 117
CHAPTER 7 INSTRUCTIONAL STRATEGIES 121

1. Introduction 121
2. Lecture Method 121
3. Discussion 123
4. Small Group Discussion 124
5. Demonstration 125
6. Lecture-Cum-Demonstration Method 126
7. Simulation 127
8. Seminar 129
9. Panel Discussion 130
10. Symposium 132
11. Workshop 132
12. Project Method 135
13. Role Play 137
14. Field Trip 140
15. Exhibition 141

viii | Contents
16. Clinical Teaching Methods 142

17. Bedside Clinic 144
18. Nursing Rounds 145
19. Nursing Report 146
20. Individual Conference 146
21. Group Conference 146
22. Nursing Care Plan 147
23. Nursing Case Study 147
24. Process Recording 148
25. Common Problems in Clinical Teaching 148
26. Problem Based Learning 148
27. Programmed Instruction 151
28. Computer Assisted Instruction (CAI)/Computer
Assisted Learning (Cal) 155
CHAPTER 8 EDUCATIONAL MEDIA 162

1. Introduction 162
2. Definition of AV Aids 162
3. Purposes of AV Aids 163
4. Principles of AV Aids 164
5. Key Concepts in the Selection and Use of Media 164
6. Teacher’s Role in Procuring and Managing Instructional Aids 166
7. Types of AV Aids 167
CHAPTER 9 MICROTEACHING 188

1. Introduction 188
2. Origin of Microteaching 188
3. Concept of Microteaching 189
4. Steps of Microteaching 189
5. Microteaching Cycle 190
6. Phases of Microteaching: Role of the Teacher-Trainer 191
7. Assumptions of Microteaching 192
8. Teaching Skills 192
9. Important Teaching Skills and their Specifications 193

Contents | ix
CHAPTER 10 MEASUREMENT AND EVALUATION 197

1. Introduction 197
2. Concepts of Measurement, Assessment and Evaluation 197
3. Process of Evaluation 200
4. Problems in Evaluation/Measurement 200
5. Principles of Evaluation 202
6. Types of Evaluation 202
7. Summative Assessment 206
8. Internal Assessment and External Examination: Advantages and
Disadvantages 207
9. Internal Assessment 208
10. Criterion- and Norm-Referenced Evaluation 209
11. Demerits of Continuous Comprehensive Evaluation 211
CHAPTER 11 EVALUATION TOOLS 215

1. Introduction 215
2. Standardized Tests 215
3. Non-Standardized Tests 216
4. Characteristics of a Good Test 217
5. Reliability 218
6. Measure to Improve Reliability 219
7. Objectivity 219
8. Evaluation Tools for the Assessment of Knowledge 219
9. Evaluation of Skills 228
10. Evaluation of Attitude 237
11. Sociometry 241
12. Item Analysis 242
CHAPTER 12 CURRICULUM DEVELOPMENT 248

1. Introduction 248
2. Meaning and Definition 248
3. Purposes of Curriculum 249
4. Types of Curriculum 249
5. Principles of Curriculum 251
6. Forces & Issues Influencing Curriculum Development 252
7. Curriculum Development 254

x | Contents
8. Four Key Components of Educational Objectives 257

9. Selection of Learning Experience 259
10. Evaluation of the Curriculum or Learning Experiences 262
11. Curriculum Development Models 262
12. Curriculum Development and Action Research 271
CHAPTER 13 INFORMATION, EDUCATION, AND

COMMUNICATION FOR HEALTH 275
1. Introduction 275
2. Defining Health Behavior 275
3. Health Education 279
4. Mass Media/Mass Approach for Health Education 283
5. Health Education in India 287
6. Role of the Health Educator 288
CHAPTER 14 GUIDANCE AND COUNSELING 293

1. Introduction 293
2. Guidance 293
3. Purpose of Guidance 296
4. Principles of Guidance 296
5. Need for Guidance 297
6. Counseling 297
7. Group Counseling 307
8. Qualities of a Counselor 307
9. Skills/Techniques Required for Effective Counseling 308
10. Role and Preparation of Counselor 309
11. Organization of Counseling Services 310
12. Role of Guidance Counselor 313
13. Tools for Counseling 314
14. Problems in Counseling 316
15. Managing Disciplinary Problems 317
16. Management of Crisis and Referral 319

Contents | xi
CHAPTER 15 IN-SERVICE EDUCATION 328

1. Introduction 328
2. Nature and Scope of In-Service Education 328
3. Concept of Staff Development 328
4. Need for In-Service Education 330
5. Characteristics of In-Service Education 331
6. Principles of Adult Learning 331
7. Areas of In-Service Education 332
8. System Approach To In-Service Education Process 332
9. Organizing In-Service Education Program 333
10. Benefits of Ongoing In-Service Education 335
11. Problems in Staff Development 335
12. Preparation of Report 335
Appendix 342
CHAPTER 16 NURSING EDUCATION PROGRAMS IN INDIA 349

1. Introduction 349
2. Diploma Courses 349
3. Degree Courses 350
4. Postbasic Diploma Programs 359
References 361
Index 362


Foreword
Nursing is a profession that caters to those who are in need of health care
services. It calls for great dedication to serve the sick and those of frail
health. A competent nurse must be skilled in nursing care and have a positive
attitude towards the profession. The delivery of knowledge, skill and attitude
to the future nursing generation is a matter of education. Nursing education
has evolved rapidly over the last few decades in India. Rapid advancement in
science and information technology has influenced the nursing educational
technology across the globe. Of late, the academy has entered in the arena
of e-learning and m-learning, though the pace is somewhat slow in India.
Flourishing health tourism in India and the mandate of quality assurance
model by Indian Nursing Council has influenced the quality of nursing
education positively; however, there is a great scope to improve upon. The quality of nursing education
is significantly determined by the competency of nurse educators in various teaching skills as well as
their scientific potential. The other important and often neglected area that needs to be strengthened is
evaluation strategy. Summative evaluation needs to be emphasized and formative evaluation should
be made more objective with the improvement in the formats of question papers of undergraduate and
postgraduate courses.
Most of the Indian books lack in scientific merit, continuity of the content and clarity of
concepts, which indeed is not acceptable in this scientific profession. I hope this book will serve
as an excellent, scientific text which will definitely be helpful for B.Sc. Nursing, Post-basic
B.Sc. Nursing, M.Sc. Nursing students as well as for nurse educators. Written as per the syllabus
prescribed by the Indian Nursing Council, the book includes a number of educational quotes which
makes the text interesting to read. Use of enormous line diagrams splits the complex concepts in to
simpler forms and helps in better understanding. Use of research evidences throughout the text provides
scientific merit to the book. Concrete examples, which are given throughout the book will enable better
understanding of the abstract concepts. I hope the book will be welcomed by the nursing professionals
across the nation.
Dr. (Mrs) Jasbir Kaur
Principal, College of Nursing,
Dayanand Medical College & Hospital, Ludhiana
Dean, Faculty of Nursing Sciences
Baba Farid University of Health Sciences, Faridkot
President, TNAI, Punjab State Branch


Preface
Nursing is an evolving scientific discipline. In the recent years, major thrust

is placed upon integration of research evidences in to the practice of nursing
to improve the quality of nursing care. Being a vital aspect of the profession,
nursing education is concerned with the delivery of knowledge, attitude and
practice to the future generation.
Unfortunately, nurse professionals are less concerned with the integration
of research evidences in to the practice of nursing in India. Most of the Indian
books in this field fail to kindle and interest in the subject among the students,
since they lack a scientific approach.
This book addresses the issue of scientific inadequacy in the content by incorporating the latest
available research evidences while making modest attempt to ensure that the student can understand the
basic principles and concepts underlying Andragogy. It also incorporates a number of quotations that
encapsulate the principles of education throughout the text to make the book interesting to the readers.
The text is designed for both new and experienced faculty and is based on the conviction that
teaching can be improved if evidences from research are applied in to student’s learning. The text is
highly structured with clear delineation of chapter sections and subsections.
As educators, we all have same goal that is to help our students make the maximum possible
academic gains in a positive respectful environment that promotes their success and nurtures their desire
to learn. Sincere and honest efforts have been put to explain how different custom-tailored strategies can
be utilized to achieve this goal.
The book has interwoven the basic principles of education in to the nursing discipline and is
in accordance with the current syllabus prescribed by the Indian Nursing Council for B.Sc. (basic)
Nursing, Post-basic B.Sc. Nursing and M.Sc. Nursing students. I hope the readers will find it a useful
text and enjoy the reading throughout.
ACKNOWLEDGEMENT
Firstly, I thank the Lord Almighty for all the blessings and mercies He showers upon me always. Without
his grace, this task would not have been possible.
It is my proud privilege to express my deepest regards and heartfelt gratitude to Dr Asha Sharma
for her valuable suggestions and support in completing this endeavor.
I am grateful to my all teachers at the College of Nursing, All India Institute of Medical Sciences,
New Delhi, for bringing precision and lucidity in my educational concepts, which lend a hand to me
throughout this project.
Frontmatter.indd 15 6/7/2012 2:44:53 PM

xvi | Preface
I am indebted to Dr (Mrs) Jasbir Kaur, Principal, College of Nursing, DMC&H, for her constant
motivation and encouragement, without which this project would not have been possible.
My special thank to Ms Tara K. Sahota Nursing Tutor, CON, DMCH, and Ms Mamta Choudhary
for their untiring efforts in language editing and providing precious suggestions.
I am obliged to Mr H. C. Rawat, Vice Principal, CON, Baba Farid University of Health Sciences,
Fardikot, Mrs Mandeep Kaur Chahal, Lecturer, CON, DMCH, Mrs Prerna Pandey, Principal,
Sri Aurobindo Institute of Medical Sciences, Indore, Mrs Vimlesh Fadrick, Lecturer, Govt. CON, SMS
Medical College and Hospital, Jaipur, and Mrs Sunita Mishra, Principal, Jaipur College of Nursing,
Jaipur, for their suggestions, which added another feather in this project.
I put across my deep gratitude to my parents Mrs Jawala and Mr Sawai Lal Patidar and my wife
Krati Patidar for their intense care and concern, which assisted me in accomplishing this task.
Last but not least, credit to my sweet daughter Nischal Patidar and son Yash Patidar for their love
and the time that they spent alone when I was busy writing.
Anurag Bhai Patidar
Frontmatter.indd 16 6/7/2012 2:44:53 PM

c h a p t e r 1
Review of Communication
Process
1. INTRODUCTION
Communication is the activity of conveying information. Communication has been derived from the
Latin word “communis,” which means “to share.” Communication requires a sender, a message, and
an intended recipient. However, the receiver need not to be present or be aware of the sender’s intent
to communicate at the time of communication; thus, communication can occur across vast distances in
time and space. Communication requires that the communicating parties share an area of communica-
tive commonality. The communication process is complete once the receiver has understood the mes-
sage of the sender. Feedback is critical for effective communication between parties.
Words are the most powerful drug used by mankind

—Rudyard Kipling
Communication is part and parcel of our day-to-day professional as well as social life. It is interwo-
ven in all nursing activities and is an inseparable part of the nursing process. The nurse has to commu-
nicate patient information and other facts to the members of health care team to achieve health-related
goals of the patient. Similarly, she has to communicate with the patients while assessing, planning,
implementing, and evaluating nursing care.
Example: Mrs. Radhika is a newly appointed staff nurse who got her first posting in Coronary
Care Unit. She is assigned to Mr. Anjuman who is suffering with congestive heart failure and was
admitted two days before. At the time of routine ward round, the doctor prescribed tablet digoxin
0.25 mg OD. Unfortunately, the doctor’s handwriting was very poor and he did not mention 0 (zero)
before .25. Mrs. Radhika misunderstood it as 25 mg and administered the same dose (25 mg) to the
patient. Although, she was in doubt about the correctness of the dose, but she did not clarify it with
the doctor or with a senior colleague because of some reason. The patient developed severe brady-
cardia and dysponea after 20 minutes of administration of the drug. Fortunately, he survived because
of immediate treatment provided to him for digoxin toxicity and bradycardia. In this situation, the
question arises that why all this happened to Mr. Anjuman? The answer: it happened due to lack of
communication between the nurse and doctor. When in doubt due to poor handwriting of doctor, she
must verify the dose from the concerned doctor or senior staff. The doctor also requires improvement
in his handwriting so that this type of medication errors can be avoided.
Chapter 01.indd 1 5/18/2012 11:38:55 AM

2 | Communication and Nursing Education
In India, this is the particular skill that needs to be emphasized among all nurses as available evi-
dences suggest that majority of the Indian nurses either are poor in communication skills or are not
using it effectively as a professional nurse due to a variety of reasons.
Communication is a skill that can be learned in the same way as other nursing skills. Indeed, it will
require some training similar to other nursing skills to learn it effectively. In the context of nursing edu-
cation, communication is considered as a teaching skill. Without communicating the intended learning
outcomes and contents effectively to the learners, learning cannot take place. So, to deliver effective
teaching, a nurse-teacher must be a good communicator, which requires the understanding of the pro-
cess and techniques of communication.
2. DEFINITION
Communication can be defined as the exchange of opinion, ideas, information, facts, feelings, and val-
ues between two or more persons (sender and receiver/s) with the help of some channels to accomplish
the desired purpose.
Vestal (1995) defined communication as “the exchange of meanings between and among individual
through a shared system of symbols (verbal and nonverbal) that have the same meaning for both the
sender and receiver of the message.”
Murphy and Hildebrandt defined communication as “a process of transmitting and receiving verbal
and non-verbal messages that produce a response.”
Joseph A. Devito mentioned that “communication refers to the act by one or more persons of send-
ing and receiving messages that are distorted by noise, occur within a context, have some effect, and
provide some opportunity for feedback.”
Communication is a cyclic process that involves initiation, transmission, and reception of informa-
tion. The reception of information is followed by the feedback, which in turn can repeat the cycle of
communication.
10% Words
30% Sounds
60%
Body Language
Communication is represented by:

10% words–what we say verbally
30% sounds–tone of voice
60% body language–how we say it (nonverbal)
Figure 1.1 Factors that Influence Verbal Communication
Chapter 01.indd 2 5/18/2012 11:38:55 AM

Review of Communication Process | 3
3. PROCESS, ELEMENTS, AND CHANNELS OF COMMUNICATION

3.1. Process of Communication
Communication is a cyclic process that starts when the sender feels that there is a need to communicate
with the receiver for a particular reason (purpose).
The sender creates a message either in the written or in verbal or nonverbal form. The message is dis-
patched to the receiver with the help of channels of communication. The receiver takes the delivery of
the message and provides feedback to the sender. The sender gets the feedback and determines whether
the receiver has received the same message and meaning that the sender had intended to communicate
with him; if the sender feels that the receiver has not received the same message and meaning, he/she
again initiates the cycle of communication (refer Figure 1.2).
3.2. Elements of Communication

On the basis of Figure 1.2, the elements of communication are as follows:
1. Sender
2. Message
3. Channel of communication
4. Receiver
5. Feedback
1. Sender: The sender is the person who initiates the process of communication. Whenever the sender
feels that there is a need to communicate some information to the other person (receiver), he/she
starts the process of communication. The sender must be aware of the purpose of the communica-
tion and the receiver’s abilities to understand the message in terms of language, interest, etc.
2. Message: The message is created by the sender to convey the information, facts or opinion to the
receiver. The message should be clear and simple so that the receiver can understand it in the same
Message:
Channel/medium
Sender How are Receiver
you? (Face to face, mobile, letter)
Feedback
All is
well...........
Figure 1.2 Communication Process
Chapter 01.indd 3 5/18/2012 11:38:56 AM

way as the sender desires. While creating a message, the sender should take care of words, lan-
guage, and meaning of the message if the message is to be communicated in verbal or written form
or he/she should take care of body language and facial expression if the message is to be commu-
nicated in nonverbal form, along with the abilities and professional competencies of the receiver.
3. Channels of communication: Communication channels are the medium through which the message
is communicated to the receiver. Channels of communication play an important role in the process of
communication. If the sender selects an appropriate medium or channel of communication, there are
more chances that the receiver will receive the same message; or else, there are chances that the mes-
sage may get distorted. In this hi-tech era, there are a number of channels that can be used to com-
municate message, e.g., mobile, e-mail, voice mail, person, radio, TV, Internet, blogs, etc. “Through
proper channel” is a common phrase used among the nurse administrators/managers that signifies
the importance of communication channels. For example, a student of B.Sc nursing, II year, wants
to communicate hostel problems to the director of the institute. In order to reach to the intended
receiver first, he/she should communicate his/her message in the form of written application to the
class teacher; the class teacher will forward the application (message) to the principal and finally the
principal will forward the application to the director. That is how communication through proper
channel takes place. In this case, the class teacher and principal were the channels of communication
through which the message was communicated to the receiver (director).
4. Receiver: The receiver is the person who receives the message. The receiver may be a single
person or a group of persons. The receiver understands the meaning of the message and provides
feedback to the sender. The receiver should have the same language ability, comprehension, and
cultural background as the sender. If not, it may lead to distorted understanding of the meaning of
the message by the receiver.
5. Feedback: It is the most crucial element of communication. It is provided by the receiver to the
sender. Receiving feedback is important for the sender to know that the receiver has received the
message and interpreted the meaning of the message in the desired way. Without feedback, the
process of communication cannot be complete. For example, when you send a mobile SMS to your
friend, you get feedback in the form of delivery report that informs you whether your message has
been delivered or not to the intended receiver; it also happens in the same way in the case of e-mail.
4. TYPES OF COMMUNICATION
Communication may be of different types depending upon the context in which the term communica-
tion is used. The important types of communication are shown in Figure 1.3.
4.1. Verbal Communication

When the sender conveys information, facts, and opinion either verbally or in writing to the receiver
using different channels of communication, it is known as verbal communication. The sender should se-
lect appropriate words and language to communicate the message to the receiver. Figure 1.4 highlights
the guidelines that should be followed to make the verbal communication effective.
4.2. Nonverbal Communication

Nonverbal communication takes place without the use of words. Nonverbal communication involves the
unconscious mind acting out emotions related to the verbal content, the situation, and the environment.
Chapter 01.indd 4 5/18/2012 11:38:56 AM

VERBAL
THERAPEUTIC
NONVERBAL
COMMUNICATION
TYPES
INFORMAL
META
FORMAL
Figure 1.3 Types of Communication
Use simple unambiguous words

Use simple and short statements
Identify and use the language that can be easily understood by the
receiver
Use clear and audible voice
Avoid being monotonous, create variations in tone as per the requirement

of the message
Body language and face expressions must be congruent with your verbal
message
Figure 1.4 Guidelines for Effective Verbal Communication
Chapter 01.indd 5 5/18/2012 11:38:57 AM

The sender uses the body language, facial expression, hand movements, eye movements, etc. to con-
vey the feelings, emotions, and other information to the receiver. This type of the communication can
be useful when both the sender and the receiver don’t have an understanding of a common language.
This technique of communication is especially useful when you are dealing with a client who is deaf
and dumb.
Knapp and Hall (2002) provided a list of the ways how nonverbal messages accompany verbal mes-
sages (Figure 1.5).
The interesting fact about nonverbal communication is that it reflects a more accurate description of
one’s true feelings because nonverbal reactions cannot be controlled easily by the people. Nonverbal
communication may include:
❑❑ Vocal cues
❑❑ Gestures
❑❑ Posture
❑❑ Physical appearance
❑❑ Distance or spatial territory
❑❑ Position or posture
❑❑ Touch
❑❑ Facial expression
It involves the use of flashing eyes or hand movements to

emphasize or put stress on important points of discussion.
Accent
It involves rolling eye movement and head nodding to

show that the meaning is the reverse of what one is saying
Contradict
It involves taking a deep breath to demonstratc readiness to

speak, uttering “and uh” to communicate the wash to
continue speaking.
Regulate
It involves culturally determined body movements that

stand in for words: for example showing two fingers
separated apart with happiness and joy indicate success
Substitute
Figure 1.5 Nonverbal Ways to Accompany Verbal Communication (Kappa and Hall, 2002)
Chapter 01.indd 6 5/18/2012 11:38:57 AM

4.3. Meta Communication

Meta communication is an important and useful tool for the effective interpersonal interaction. It is
“communication about communication” so that the deeper “message within a message” can be un-
covered and understood (Wood, 1999). This type of method is useful among a group of experts in a
particular area.
4.4. Formal Communication

Formal communication is a type of communication which is used in the context of organization where
a large group of employees work together to accomplish goals of organization. Formal communications
usually take place in the form of written communication, which follows the lines of authority or scalar
chain of command.
4.5. Informal Communication

Informal communication refers to the gossip or informal talks that take place among the various
groups of people working in an organization that don’t follow organizational line of authority or
hierarchy.
4.6. Therapeutic Communication

Therapeutic communication is a type of communication that takes place in the health care environment
between nurse and patient. Therapeutic communications is a planned, deliberate, and professional act
that uses communication techniques to achieve a positive relationship and shared understanding of
information for the desired patient-care goals. The purpose of therapeutic communication is to ex-
plore the client’s problems, planning the interventions along with the client and implementing these
interventions. During therapeutic communication, the nurse encourages the client to communicate fear,
anxieties, expectations, and self-care deficit needs. The nurse uses special techniques while engaging
in the therapeutic communication with the client, e.g., active listening, asking open-ended questions,
paraphrasing, etc.
5. LEVELS OF COMMUNICATION
Levels of communication are determined on the basis of the number of people involved in the process
of communication as well as on the purpose of communication. These levels of communication are
depicted in Figure 1.6.
5.1. Intrapersonal Communication

Intrapersonal communication refers to communication with the self. It may be silent or verbal type of
communication. Intrapersonal type of communication approximates with the thinking process, in which
the person consciously sends information to himself/herself in order to analyze a situation. This commu-
nication strategy is particularly useful when someone has to make important life decisions or is facing
a conflicting situation. “Positive self-talk” is a type of intrapersonal communication that can be used as
a tool to improve the nurses or client’s health and self-esteem.
Chapter 01.indd 7 5/18/2012 11:38:57 AM

INTRA
PERSONAL
PUBLIC
COMMUNICATION
INTER
PERSONAL
LEVELS OF
COMMUNICATION
SMALL GROUP
COMMUNICATION TRANS
PERSONAL
Figure 1.6 Levels of Communication
5.2. Interpersonal Communication

It refers to one-to-one interaction between two persons that often occurs face to face. The purpose of in-
terpersonal communication is to share information, opinion, ideas, and so on (Figure 1.7). Interpersonal
communication can be further divided into three types:
5.2.1. Assertive Communication

It is a type of interpersonal communication that has the following characteristics:
❑❑ Confidently expressing what you think, feel, and believe.
❑❑ Raising voice for your rights while respecting the rights of others.
❑❑ Conveying meaning and expectations without humiliating or degrading others.
❑❑ Based upon respect for you and respect for other people’s need and rights.
It is noteworthy here that, unfortunately most of the nurses are not using assertive communication
in their professional life because of so many reasons. There is a need to change the current situation,
and the responsibility lies on young budding nurses so that the professional image of the nurses can be
improved in India.
5.2.2. Nonassertive Communication

Nonassertive communication is characterized as follows:
❑❑ Inability to express consistently what you think, feel, and believe.
❑❑ Allowing others to violate your rights without challenge.
Chapter 01.indd 8 5/18/2012 11:38:58 AM

Assertive communication
1
Nonassertive communication
2
Aggressive communication
3
Figure 1.7 Types of Interpersonal Communication
❑❑ Reflecting lack of respect for your own preferences.

❑❑ Others can easily disregard your thoughts, feelings, and beliefs.
It cannot be considered a good communication strategy for a professional nurse.
5.2.3. Aggressive Communication

Aggressive communication takes place when someone expresses himself/herself in ways that intimi-
date, demean, or degrade another person, pursuing what you want in ways that violate the rights of
another person. It is considered as an unsuitable communication technique for a professional nurse.
5.3. Transpersonal Communication

Communication that occurs within a person’s spiritual domain is referred as transpersonal communi-
cation. The purpose of transpersonal communication is to realize self-hood, enhance spirituality, and
answer the questions that are spiritual in nature.
5.4. Small-group Communication

This type or level of communication takes place within a small group. The purpose of small-group com-
munication is to communicate information that is of common interest to group members or sometimes
to know the opinions of group members to arrive at a decision.
5.5. Public Communication

Public is usually considered as a large group of people or laypersons with a vast difference in a num-
ber of factors, e.g., socioeconomic status, literacy level, occupation, and habitat. Communication to
public serves some purposes that benefit the common man (e.g., health education) or sometimes to
make requests or to get favors from the public in general elections. Public communication requires
special communication skills as the size of the group is very large with so many differences among the
group members as described earlier. There is a need to maintain different types of eye contact with the
public, gestures, and voices, and media materials should be used to communicate messages effectively.
Chapter 01.indd 9 5/18/2012 11:38:59 AM

5.6. Social Communication

Social communication takes place in the social context. Being a social animal, human beings establish
relationship with other people to accomplish several purposes throughout their life span. In order to
keep these social relations alive and being social, one has to communicate with others. “Good morning.
How are you?” “How are your children?” This type of communication is one’s social obligation to com-
municate within his/her social group to which he/she belongs.
6. FACTORS INFLUENCING COMMUNICATION

There are certain factors that influence the process of communication, which are described briefly here.
6.1. Attitude
Attitude is referred to the internal predisposition of a person to act in a certain way toward a situation.
The attitude of a person toward the given situation is influenced by the peers, parents, environment, life
experiences, perception, and intellectual processes. A person may have the attitude of accepting, preju-
diced, judgmental, negative, open and close, etc.
A person with negative attitude may respond with “I’m sure it is of no use, it will not work ulti-
mately.” On the other hand, a person with positive attitude will reply “come on guys, let us try it, we
have nothing to lose.”
6.2. Sociocultural Background

Various cultures and ethnic groups display different communication patterns. For example, people of
French or Italian heritage often are gregarious and talkative and willing to share thoughts and feelings.
People from Southeast Asian countries such as Thailand or Laos are quiet and reserved. They appear
stoic and reluctant to discuss personal feelings with persons outside their families.
6.3. Past Experiences

Previous positive or negative experiences influence one’s ability to communicate. For example, teenag-
ers who have been criticized by parents whenever attempting to express any feelings may develop a
poor self-image and feel that their opinions are not worthwhile. As a result, they may avoid interacting
with others, become indecisive when asked to give an opinion, or agree with others to avoid what they
perceive to be criticism or confrontation (nonassertive).
6.4. Knowledge of Subject Matter

A person who is well-educated or knowledgeable about certain topics may communicate with others at
a high level of understanding. The receiver who is relatively less knowledgeable of the topic under dis-
cussion may be unable to comprehend the message or consider the sender to be an expert. As a result of
this misperception, the receiver may neglect to ask questions and may not receive the correct informa-
tion. For example, nurses are required to communicate with the patient in a language that is understand-
able to the patient (patient’s native language). She is also required not to use jargons while delivering
health education or some other useful information to the patient. The educational status of the patient
must be taken into consideration while communicating with the patient.
Chapter 01.indd 10 5/18/2012 11:38:59 AM

6.5. Ability to Relate with Others

Some people are “natural-born talkers” who claim to have “never met a stranger.” Others may possess
an intuitive trait that enables them to say the right thing at the right time and relate well to people. “I feel
so comfortable talking with her,” “She is so easy to relate to,” and “I could talk to him for hours” are
just a few comments made about people who have the ability to relate well with others. These persons
are considered as good communicators.
6.6. Interpersonal Perception

Interpersonal perceptions are mental processes by which intellectual, sensory, and emotional data are
re-organized logically and meaningfully, which determine how we perceive others. Inattentiveness,
disinterest, or lack of use of one’s senses during communication can result in distorted perceptions of
others. Satir (1995) warns of looking without seeing, listening without hearing, touching without feel-
ing, moving without awareness, and speaking without meaning. The following passage reinforces the
importance of perceptions: “I know that you believe you understand what you think I said, but I’m not
sure you realize that what you heard is not what I said.”
6.7. Environmental Factors

Environmental factors such as time, place, number of people present, and noise level can influence com-
munication between people in that particular surrounding. Timing is important during a conversation; a very
well-timed response catches the attention of others. The place in which communication occurs, as well as the
number of people present and noise level, has a definite influence on interactions among people (Figure 1.8).
Interpersonal
perception
Attitude
Environmental
factors
Factors
influencing
communication Sociocultural
Knowledge of background
subject matter
Past
Ability to relate experiences
with others
Figure 1.8 Factors Influencing Communication
Chapter 01.indd 11 5/18/2012 11:38:59 AM

7. BARRIERS OF COMMUNICATION
Communication plays a major role in developing a relationship. It can also affect the relationship
among family members or management in any institute. More specifically, communication influenc-
es the effectiveness of instruction, performance evaluation, and the handling of discipline problems.
Communication should be straightforward. What can make it complex, difficult, and frustrating are the
barriers. Some barriers of communication are the following.
7.1. Physiological Barrier

Physiological barriers to communication are related with the limitations of the human body and the
human mind (memory, attention, and perception). Physiological barriers may result from individuals’
personal discomfort, caused by ill-health, poor eye sight, or hearing difficulties.
7.1.1. Poor Listening Skills

Listening to others is considered a difficult task. A typical speaker says about 125 words per minute.
The typical listener can receive 400–600 words per minute. Thus, about three-fourth of listening time
is free time. The free time often sidetracks the listener. The solution is to be an active rather than pas-
sive listener. A listener’s premature frown, shaking of the head, or bored look can easily convince the
other person/speaker that there is no reason to elaborate or try again to communicate his/her excellent
idea.
7.1.2. Information Overload

Nurses are surrounded with a pool of information. It is essential to control the flow of the information,
else the information is likely to be misinterpreted or forgotten or overlooked. As a result, communica-
tion may get distorted.
7.1.3. Inattention
At times, we just do not listen but only hear. For example, your boss is immersed in his/her very impor-
tant paper work surrounded by so many files on the table and you are explaining him/her about an urgent
office problem. In this situation, due to the inattention, the boss will not listen to you (he/she will only
hear you); hence, he/she may not get what you are saying and it may lead to disappointment.
7.1.4. Emotions
The emotional state of a person at a particular point of time affects his/her communication with others as
it has an impact on the body language (nonverbal communication). If the receiver feels that the sender
is angry (emotional state), he/she can easily infer that the information being obtained will be very ter-
rible. Emotional state causes some physiological changes in our body that may affect the pronunciation,
pressure of the speech, and tone of the voice of the sender as well as the perception, thinking process,
and information interpretation of the receiver during verbal communication.
7.1.5. Poor Retention

Human memory cannot function beyond a limit. One cannot always retain all the facts/information
about what is being told to him/her especially if he/she is not interested or not attentive. This leads to
communication breakdown.
Chapter 01.indd 12 5/18/2012 11:38:59 AM

7.2. Physical and Environmental Distractions

Physical distractions are the physical things that get in the way of communication. Examples of such
things include the telephone, an uncomfortable meeting place, and noise. These physical distractions are
common in the hospital setting. If the telephone rings, the usual human tendency will be to answer it even
if the caller is interrupting a very important or even delicate conversation. Distractions such as back-
ground noise, poor lighting, uncomfortable sitting, unhygienic room, or an environment that is too hot or
cold can affect people’s morale and concentration, which in turn interfere with effective communication.
7.3. Psychological Barrier

Psychological factors such as misperception, filtering, distrust, unhappy emotions, and people’s state of
mind can jeopardize the process of communication. We all tend to feel happier and more receptive to
information when the sun shines. Similarly, if someone has personal problems such as worries and stress
about a chronic illness, it may impinge his/her communication with others.
7.4. Social Barriers

Social barriers to communication include the social psychological phenomenon of conformity, a process
in which the norms, values, and behaviors of an individual begin to follow those of the wider group.
Social factors such as age, gender, socioeconomic status, and marital status may act as a barrier to com-
munication in certain situations.
7.5. Cultural Barriers

Culture shapes the way we think and behave. It can be seen as both shaping and being shaped by our estab-
lished patterns of communication. Cultural barrier to communication often arises when individuals in one
social group have developed different norms, values, or behaviors to individuals associated with another
group. Cultural difference leads to difference in interest, knowledge, value, and tradition. Therefore, peo-
ple of different cultures will experience these culture factors as a barrier to communicate with each other.
7.6. Semantic Barrier

Language, jargon, slang, etc., are some of the semantic barriers. Different languages across different
regions represent a national barrier to communication, which is particularly important for migrating
nurses. Use of jargon and slang also act as barrier to communication. For example, while delivering
health education to a cardiac patient, if a cardiac nurse uses jargons such as “coronary artery disease,”
“anticoagulants,” and “homocysteine and C-reactive proteins,” the patient will listen attentively as he/
she cannot understand these medical jargons. Therefore, she is required to use simple words “heart ki
nadi ki bimari,” “khoon patla karne ki dawai,” and “certain chemicals in our body” so that the patient
can understand what the nurse is supposed to communicate with him/her.
7.7. Linguistic Barriers

Individual linguistic ability may sometimes become a barrier to communication. The use of difficult or
inappropriate words in communication can prevent the people from understanding the message. Poorly
explained or misunderstood messages can also result in confusion. The linguistic differences between
Chapter 01.indd 13 5/18/2012 11:38:59 AM

the people can also lead to communication breakdown. The same word may mean differently to differ-
ent individuals. For example, consider a word “face.”
❑❑ He is facing a problem
❑❑ What is the face value of this share bond?
❑❑ Your face is oval shape
“Face” means differently in different sentences. Communication breakdown occurs if there is wrong
perception of the meaning of the message by the receiver.
7.8. Past Experience

If someone has awful experiences in the past related to some particular situation, then he/she will try
to avoid communication in that situation. For example, a staff nurse who, while providing detailed
information regarding the patient care at the time of routine clinical round to her boss, is always facing
negative body language and discouraging words from her boss will ultimately limit her communication
to the boss at that time.
7.9. Organizational Barriers

Unclear planning, structure, information overload, timing, technology, and status difference are the
organizational factors that may act as barriers to communication.
7.9.1. Technological Failure

Message not delivered due to technical failure (e.g., receiver was not in mobile network area and the
sender has not activated delivery report in message setting).
7.9.2. Time Pressures

Often, in organization the targets have to be achieved within a specified time period, the failure of which
may have adverse consequences for the employee. In a haste to meet deadlines, usually an employee
tries to shorten the formal channels of communication that can lead to confusion and misunderstanding
among the various levels of supervisors, hence leading distorted communication. Therefore, sufficient
time should be given for effective communication.
7.9.3. Complexity in Organizational Structure

Greater the hierarchy in an organization (i.e., the more the number of managerial levels), more are the
chances of communication getting destroyed. Only the people at the top level can see the overall picture
while the people at low level just have a knowledge about their own area and a little knowledge about
other areas of the organization.
7.10. Barriers Related with the Message

7.10.1. Unclear Messages
Effective communication starts with a clear message. Unclear messages in terms of meaning, grammar,
and words may act as a barrier to communication because the receiver may not be able to intercept the
actual meaning of the message.
Chapter 01.indd 14 5/18/2012 11:38:59 AM

7.10.2. Stereotypes
Stereotypes are beliefs or generalizations about characteristics or qualities that are felt to be typical of a
particular group (Funk & Wagnalls, 1966). Stereotyping is a barrier to communication because people
with stereotype thoughts either will not read the message completely or will not read it at all because of
their thinking that they already know everything (Figure 1.9).
7.10.3. Inappropriate Channel

Variation of channels helps the receiver understand the nature and importance of a message. While
making a choice for a channel of communication, the sender needs to be sensitive to such things as the
complexity of the message; consequences of a misunderstanding; knowledge, skills, and abilities of the
receiver; and immediacy of action to be taken from the message.
7.10.4. Lack of Feedback

Feedback is the mirror of communication. Feedback mirrors what the sender has sent. Without feed-
back, communication cannot be considered complete. Both the sender and the receiver can play an ac-
tive role in using feedback to make communication truly two-way.
7.11. Some Other Blocks to Communication

❑❑ Failure to listen: Communicator may or may not feel able to speak freely to the listener, if the
listener is not listening carefully or not responding.
❑❑ Conflicting verbal and nonverbal messages.
❑❑ Failure to interpret with knowledge.
❑❑ Changing the subject: A quick way to stop conversation is to change the subject.
❑❑ Inappropriate comments and questions: Certain types of comments and questions should be
avoided in most situations because they tend to impede effective communication, e.g., close-
ended questions and using comments that give advice.
8. M ETHODS OF OVERCOMING BARRIERS OF COMMUNICATION

OR FACILITATING COMMUNICATION
Overcoming the communication barriers requires a vigilant observation and thoughts of potential barri-
ers in a particular instance of communication. State all the anticipated barriers that may have impact on
your day-to-day communication. Strategies to overcome barriers will be different in different situations
depending upon the type of barriers present. Following are some of the important general strategies that
will be commonly useful in all the situations to overcome the barriers of communication.
❑❑ Taking the receiver more seriously

❑❑ Crystal clear message
❑❑ Delivering messages skillfully
❑❑ Focusing on the receiver
❑❑ Using multiple channels to communicate instead of relying on one channel
❑❑ Ensuring appropriate feedback
❑❑ Be aware of your own state of mind/emotions/attitude
Chapter 01.indd 15 5/18/2012 11:38:59 AM

Physiological Poor listening skills, information overload, inattention,

barriers emotions, poor retention
Physical and Telephone, noise, poor lighting, uncomfortable sitting,

environmental unhygienic room, and uncomfortable environment (too hot
barriers or cold)
Psychological Misperception, filtering, distrust, unhappy emotions,

barriers people’s state of mind
Social Social norms, Values, age, gender, socioeconomic status,

barriers marital status
Cultural Different cultural norms, value, traditions, cultural

barriers behaviour
Semantic
barrier Language, jargon, slang etc.
Linguistic Individual linguistic ability, difficult and inappropriate

barriers words, etc.
Past Past terrible experiences of communication in a particular

experiences situation
Technological failure, time pressure, complex

Organizational organizational structure, so many hierarchy levels,
barriers mandate of having to route through proper channel
Message-
related Unclear message, lack of feedback, inappropriate channel
barriers of communication, stereotypes
Figure 1.9 Barriers to Communication
Chapter 01.indd 16 5/18/2012 11:39:00 AM

8.1. Facilitators of Communication

In addition to removal of specific barriers to communication, the following general guidelines may be
helpful to facilitate communication:
❑❑ Have a positive attitude about communication. Defensiveness interferes with communication.

❑❑ Work at improving communication skills. The communication model and discussion of bar-
riers to communication provide the necessary knowledge to improve communication. This
increased awareness of the potential for improving communication is the first step to better
communication.
❑❑ Include communication as a skill to be evaluated along with all the other nursing skills for under-
graduates.
❑❑ Make communication goal oriented. Relational goals come first and pave the way for other goals.
When the sender and receiver have a good relationship, they are much more likely to accomplish
their communication goals.
❑❑ Experiment with communication alternatives. What works with one person may not work well
with another. Use diverse communication channels, listening and feedback techniques.
❑❑ Accept the reality of miscommunication. The best communicators fail to have perfect communi-
cation. They accept miscommunication and work to minimize its negative impacts.
❑❑ Use of simple and clear words should be emphasized. Use of ambiguous words and jargons should
be avoided.
❑❑ Noise is the main communication barrier in most of the health care settings, which must be han-
dled on priority basis. It is essential to identify and eliminate the source of noise.
❑❑ Listen attentively and carefully. There is a difference between “listening” and “hearing.” Active
listening means hearing with a proper understanding of the message. By asking questions, the
speaker can ensure whether his/her message is understood or not by the receiver in the same man-
ner as intended by him.
❑❑ The organizational structure should be simple to facilitate communication between various hier-
archy levels. The number of hierarchical levels should be optimum, and there should be an ideal
span of control within the organization. Simpler the organizational structure, more effective will
be the communication.
❑❑ The managers should know how to prioritize their work. They should not overload themselves
with the work, should spend quality time with their subordinates, and should listen to their prob-
lems and feedbacks actively.
There are 6 C’s of effective communication, which are applicable to both written and oral commu-
nication. They are as follows:
1. Complete—The message must be complete in all respect and should convey all facts required by
the receiver. Incompleteness of the message may lead to misunderstanding or incomplete under-
standing and confusion between the sender and the receiver. It is the responsibility of the sender to
make sure (before mailing the message) that the information provided in the message is complete
as per the purpose of the communication.
2. Clear—Clarity in communication makes understanding easier and enhances the meaning of a
message. A clear message uses exact, appropriate, and concrete words and avoids ambiguous
words.
Chapter 01.indd 17 5/18/2012 11:39:00 AM

Complete
Courtesy Clear
6 C’s of
Communication
Consideration Correct
Concise
Figure 1.10 6 C’s of Communication
3. Correctness—Correctness in communication implies that there are no grammatical and spelling

errors in communication.
4. Concise—Conciseness means eliminating wordiness and communicating what you want to convey
in least possible words without forgoing the other C’s of communication. Conciseness is a neces-
sity for effective communication.
5. Consideration—Consideration implies “stepping into the shoes of others.” Effective communi-
cation must take the receiver/s into consideration (i.e., the audience’s viewpoints, background,
mindset, education level, etc.). The sender should make an attempt to understand the audience,
their requirements, emotions, as well as problems. Ensure that the self-respect of the audience is
maintained and their emotions are not hurt.
6. Courtesy—Courtesy in message implies that the message should show the sender’s expression
as well as respect to the receiver. The sender of the message should be sincerely polite, judicious,
reflective, and enthusiastic (Figure 1.10).
9. TECHNIQUES OF EFFECTIVE COMMUNICATION

Effective communication techniques are useful to make the communication efficient and meaningful.
There are several techniques of effective communication, which can be used as per the context and
type of communication. For example, maintaining eye-to-eye contact with the listener is essential
for effective communication while communicating with a single person or a small group of people.
However, the technique of eye-to-eye contact has to be used in a different way while communicating
Chapter 01.indd 18 5/18/2012 11:39:00 AM

with a large group of audience. Similarly, some people are considered experts to communicate bitter
information quite comfortably, whereas, others may feel difficulty because they don’t know how to
communicate in such a situation. Likewise, some people communicate the message straightforward
without providing unnecessary detailed background information, whereas, others may provide detailed
background information before communicating the main fact. Techniques of communication used by
an individual are determined by the family environment, culture, life philosophy of the person, and
various other factors. Being a nurse, you must learn how to communicate with the patient and the
members of health care team effectively. Communication techniques are often the key to climb up the
professional ladder, and the budding nurses should master the skills earlier in their career to be a suc-
cessful nurse. Given below are some of the communication techniques that should be used by nurses
in a health care setting.
9.1. Listening Actively
To listen closely and reply well is the highest perfection we are able to attain in the art of
conversation
—La Rochefoucauld
Listening actively means to be attentive to what the other person is saying verbally and nonverbally.
Active listening is an effective communication skill for therapeutic communication, which must be
practiced and mastered by every professional nurse. Several nonverbal behaviors can facilitate the skill
of active listening which are as follows:
1. Sit squarely facing the other person, establish eye-to-eye contact.
2. Keep the posture open.
3. Lean forward toward the client.
4. Be relaxed.
5. Concentrate on what the other person is saying.
6. Restating what the other person said and showing him that you’re listening.
9.2. Use Silence

Silence during communication process can carry a variety of meanings. It provides an opportunity to the
communicator to explore his/her inner thoughts or feelings comfortably that will be required to facilitate
the communication.
9.3. Observe Nonverbal Behavior of the Client

Nonverbal cues are more important than the verbal message because 60 percent of the impact from
every conversation you have comes from your nonverbal cues. These include eye contact, your posture,
and the gestures you make.
The nonverbal cues indicate what you think, even if your words say something else entirely. Some
people don’t like to be touched, and invasion to their personal space is one nonverbal cue you can easily
avoid to facilitate communication. Nonverbal cues are just as important as any other communication
technique you’re trying to master.
Chapter 01.indd 19 5/18/2012 11:39:01 AM

9.4. Tone and Words

It is observed by communication experts that 30 percent of what you actually mean while communicat-
ing something is determined by the tone of your voice. For example, if you say that “You’ll be happy to
sacrifice this opportunity for someone,” but you’re yelling when you say it, the other person will clearly
notice that you’re actually not happy to do it. Only 10 percent of the real meaning of your conversation
is usually determined by the actual words you use. Therefore, having a big vocabulary is less important
to the communicative process than having the right hand signals and facial expressions.
9.5. Be Consistent Verbally and Nonverbally

Inconsistency in verbal and nonverbal communication by the sender may lead to confusion and misun-
derstanding of the message on the part of the receiver (Figure 1.11).
9.6. Ask Open-ended Questions

Open-ended questions encourage the client to communicate more and more, whereas, close-ended ques-
tions discourage the communication. For example, “What are your food preferences?” is an open-ended
question, whereas, “Do you like Dalia Khichdi?” is a close-ended question.
9.7. Use Language Understood by the Patient

The patient will not respond until and unless you are not using the same language as understood by
the patient. For example, you are not supposed to use Tamil while communicating with a patient who
belongs to Karnataka.
9.8. Restating
Let the client know whether an expressed statement has or has not been understood. For example, “You
told me that, you are constipated since the last two days.”
9.9. Reflecting
This directs questions or feelings back to client so that they may be recognized and accepted.
60% by
nonverbal cues
30% by (eye contact,
your tone posture, and
of voice gesture)
10% by the actual

words you use
Figure 1.11 Determinants of Verbal Communication
Chapter 01.indd 20 5/18/2012 11:39:01 AM

9.10. Focusing
This takes notice of a single idea or even a single word. For example, “You told me that, your father was
suffering from a chronic illness, which type of chronic illness it was?” Here, the nurse is focusing on
chronic illness as mentioned by the client about his father.
9.11. Exploring
This delves further into a subject, idea, experience, or relationship. For example, “You told me that your
father was not a good person, why do you think so?”
9.12. Giving Broad Openings

This allows the client to select the topic.
9.13. Offering General Leads

This encourages client to continue.
9.14. Making Observations

Verbalize what is observed or perceived.
9.15. Encouraging Description of Perceptions

Ask the client to verbalize what is being perceived.
9.16. Encouraging Comparison

Ask the client to compare similarities and differences in ideas, experiences, or interpersonal relationships.
9.17. Seeking Clarification and Validation

Strive to explain what is vague and search for mutual understanding.
Warmth and friendliness, openness and respect, and providing personal space are some other
important communication skills.
Chapter 01.indd 21 5/18/2012 11:39:01 AM

CHAPTER HIGHLIGHTS
❑❑ Communication is a skill that can be learned in the same way as other nursing skills. Indeed, it will
require some training to learn and master this skill.
❑❑ Communication can be defined as exchange of opinion, ideas, information, facts, feelings, and
value between two or more persons (sender and receiver/s) with the help of a variety of channels
to accomplish the desired purpose.
❑❑ The elements of the communication are sender, message, channel of communication, receiver,
and feedback.
❑❑ The important types of communication are verbal communication, nonverbal communication,
metacommunication, formal communication, informal communication, and therapeutic commu-
nication.
❑❑ Levels of communication include intrapersonal communication, interpersonal communication,
transpersonal communication, small-group communication, and public communication.
❑❑ Attitude, sociocultural background, past experience, knowledge of subject matter, ability to relate
with others, and environmental factors may influence the communication process.
❑❑ Barriers of communication can be categorized into psychological barriers, sociocultural barriers,
semantic barriers, linguistic capacity, physical illness, technology failure, environmental barriers,
and organizational barriers.
❑❑ For effective communication, the message should be clear, concrete, concise, and correct.
❑❑ Active listening, using silence, observing nonverbal behavior, appropriate tone and words, restat-
ing, focusing, and exploring are some of the effective communication skills.
EVALUATE YOURSELF
Q 1: Which one of the following is not an element of communication?
(a) Sender
(b) Feedback
(c) Receiver
(d) Context
Q 2: Communication is represented by _____
(a) 25% of the words
(b) 60% of the nonverbal
(c) 45% of the tone of voice
(d) All of the above
Q 3: Interpersonal communication occurs ____
(a) Between two persons
(b) Within the person
(c) Between person and the environment
(d) None of the above
Q 4: Which of the following statements is not true for communication?
(a) Communication is exchange of information between two persons
(b) Communication is influenced by environmental factors
Chapter 01.indd 22 5/18/2012 11:39:01 AM

(c) Communication is a goal-directed activity

(d) Active listening is not a part of therapeutic communication
Q 5: Which one of the following is not a characteristic of good message?
(a) Clear
(b) Concrete
(c) Concise
(d) Vague
Q 6: Explain the barriers of communication (BFUHS, 2009; MGR University, 2010; RGUHS, 2010).
Q 7: What are the channels of communication? (NTR University of Health Sciences, 2010)
Q 8: Write a short note on communication skills (NTRUHS, 2007).
Q 9: Explain nonverbal communication (NIMS, 2008).
Q 10: What are the facilitators of communication? (NIMS, 2010)
Q 11: Explain the techniques of therapeutic communication (RUHS, 2008, 2010; RGUHS, 2009).
Q 12: What are the elements of communication process? (BFUHS, 2007; RUHS, 2008, 2010; RGUHS,
2009)
Q 13: Explain the barriers of communication and the techniques to overcome these barriers?
REFERENCES/FURTHER READINGS
1. Jean C. Bradley, Mark A. Edinburgh. “Communication in the nursing context”, 2nd edition.
2. Sandra J. Sundeen. “Nurse client interaction, implementing the nursing process’’, 5th edition,
Mosby.
3. Kagan C. “Professional interpersonal skills for nurses,” print 1995, Chapman & Hall Publishers.
Chapter 01.indd 23 5/18/2012 11:39:01 AM

c h a p t e r 2
Interpersonal Relationship
1. INTRODUCTION
Human beings always strive to satisfy various social, economical, psychological, and spiritual needs;
for that reason, people establish relations with other members of the society. However, some relations
are established by birth, but others are established purposefully throughout the life of a person. A
relation is a state of affair in which at least two persons are involved and have transaction with each
other. It is a particular type of bond or connection or link existing between people who have purpose-
ful dealings with each other. Being a humanitarian discipline the core of nursing activities is inter-
personal contact, as nurses are the centre of health care team according to magnet model of nursing.
They do things for and with other people; therefore they need to be skilled in building interpersonal
relationship (IPR).
2. INTERPERSONAL RELATIONSHIP
IPRs are social associations, connections, or affiliations between two or more people—it is a mutual
fulfillment of needs. When two people have strong needs and each fulfills the other’s need, there ex-
ists a mild relationship. Similarly, when both people have strong needs and those needs are not being
satisfied, there exists a poor relationship. Hence, IPR can be simply defined as relationship that exists
between two or more persons to fulfill some goals or to satisfy the needs of each other. For optimal
growth and development of an individual as well as to ensure an enjoyable life, positive IPR is impera-
tive. It includes all the relations that an individual develop within and outside the family—for example
mother, friend, sister, nephew, etc. Responsibility of maintaining such relationship lies equally on both
the persons involved in the relation.
IPRs that are mutually satisfying both the persons involved take shape because of some personal,
social, psychological, and spiritual needs of individuals. For example, therapeutic IPRs are established
between a nurse and patient; the purpose of this relationship for a patient is to get speedy recovery from
illness and also to seek assistance in those activities that he/she cannot perform due to illness and for a
nurse engaging in therapeutic relationship is her professional obligation (because of her job demand)
and to provide efficient and quality nursing care to help the patient achieve optimal state of health.
These relationships usually involve some level of interdependence.
People in a relationship tend to influence each other, share their thoughts and feelings, and engage
in goal-directed activities together. Because of this interdependence, most things that change or impact
one member of the relationship will also have some level of impact on the other member. Some of the
relationships are dissolved when purpose or needs of both the persons are satisfied. IPRs are dynamic
Chapter 02.indd 24 5/18/2012 11:40:57 AM

Interpersonal Relationship | 25
systems that change continuously during their existence. They tend to grow and improve gradually, as
people get to know each other and become closer emotionally, or they gradually deteriorate as people
drift apart, move on with their lives, and form new relationships with others. One of the most influential
models of relationship development was proposed by the psychologist George Levinger. He proposed
the following five steps of development of IPR:
1. Acquaintance—It is the first step of development of IPR. Getting acquainted with other depends on
certain factors such as previous relationships, first impressions, and physical proximity.
2. Buildup—After getting acquainted, people begin to trust each other. During interaction, they com-
municate their likes, dislikes, need for intimacy, and physical proximity. These factors will influ-
ence whether or not interaction should continue.
3. Continuation—This stage follows when there is compatibility in likes, dislikes, intimacy, and
some other factors of common interest as communicated in buildup step. Continuation step is
generally a long, relative stable period. Mutual trust is important for continuing and sustaining
the relationship.
4. Deterioration—Not all relationships deteriorate, but certain relationships may deteriorate because
of some unusual factors such as boredom, resentment, and dissatisfaction with each other. The
concerned persons may communicate less and avoid disclosure that will eventually lead to ending
of the relationship.
5. Termination—The final stage marks the end of the relationship, either by death in the case of a
healthy relationship or by separation in a deteriorated relationship.
3. TYPES OF INTERPERSONAL RELATIONS

Relations may be of different types depending on the purpose and needs of the people. The strength of
the relationship will be determined by the underlying purpose for which they are established. Following
is a list of some important relations an individual establishes during his/her lifetime.
3.1. Blood Relation

Blood relationship is one which is established by birth. It is considered as the strongest type of relations
and superior to any other type of relations that are maintained throughout the life of a person. Blood
relations satisfy family and some other needs of a person.
3.2. Social Relation

Being a social animal, a person initiates and maintains social relation with the other members of the
society. A social relationship can be defined as a relationship established between two persons with
the purpose of friendship, socialization, or enjoyment so that both the persons can achieve a socially
satisfying life.
3.3. Business Relation

Business relations serve economic purposes between two or more persons. They are established to
benefit each other economically (Figure 2.1).
Chapter 02.indd 25 5/18/2012 11:40:57 AM

Intimate relations
Therapeutic relations Blood relations

Types of
relationship
Economical relations Social relations
Figure 2.1 Types of Relationship
3.4. Intimate Relationship

Intimate relations fulfill emotional needs of the people. Strong emotional commitment with each other
is a prerequisite for the success of this relationship. The personal space between the people engaged in
relationship is greatly reduced when the persons are in intimacy. Each one is having a caring and loving
attitude toward other. This relation may exist inside or outside the family.
❑❑ Formalized intimate relationship: Those intimated relationship that are recognized by law and ac-
cepted or formalized through ceremony, for example, relationship of husband and wife.
❑❑ Nonformalized intimate relationship: Not recognized by law as well as by the society. For ex-
ample, loving relationship in most of the societies of the India, romantic relationship, live-in
relationship.
3.5. Therapeutic Relationship

Therapeutic relationship is a type of relation that occurs between patient and the nurse or physician.
Therapeutic relationship is different from social or intimate relationship because of its underlying pur-
pose, that is, to help the client to recover from the illness. Nurse is accountable to initiate and maintain
the therapeutic relationship with the patient. Nurse accepts patient as “here and now,” without any
personal or emotional attachments and interests with him. It is considered unethical professionally if a
nurse tries to establish personal or intimate relationship with the patient under her direct care. The nurse
should only focus on the purposes of therapeutic relationship, which are as follows:
❑❑ Facilitating communication of concerns, thoughts, feeling, and anxiety between the patient and
nurse
❑❑ Mutually setting goals for care
❑❑ Assisting the client in those activities that he/she cannot perform
❑❑ Implementing the interventions that are acceptable to the patient
❑❑ Evaluating the care and replanning, whenever necessary
Chapter 02.indd 26 5/18/2012 11:40:58 AM

4. PHASES OF INTERPERSONAL RELATIONSHIP

IPR develops through some phases between patient and nurse when they come together in the health
care environment. Hildegard E. Peplau was the first person in the field of nursing who did significant
work on IPR. She published a book on “Interpersonal relationship in nursing” in 1952 and proposed
a theory of IPR in nursing. In her book, she discussed the four phases of IPR, and she mentioned that
nursing is a significant, therapeutic interpersonal process because it involves interaction between two or
more individuals (nurse and patient) with a common goal.
The four phases of IPR as discussed by Peplau are as follows:
4.1. Preinteraction Phase

This is the first phase of development of IPR in health care setting. This phase takes place when a nurse
is assigned to provide care to a patient with whom she has no prior interaction or meeting in heath care
environment. Before meeting the client, the nurse:
❑❑ Reviews available data, including the medical and nursing history of the patient.
❑❑ Talks to other caregivers who may have information about the client to gather additional health-
related data of the patient.
❑❑ Anticipates health concerns or issues that may arise during her assignment of care.
❑❑ Identifies a location and ceiling that will foster comfortable private interaction with the patient.
❑❑ Plans enough time for the initial interaction with the patient.
4.2. Orientation and Identification (Introductory) Phase

This phase starts when the nurse and client meet and get to know each other. During this phase, the
nurse:
❑❑ Sets the tone for the relationship by adopting a warm, empathetic, caring manner.
❑❑ Recognizes that the initial relationship may be superficial, uncertain, and tentative and behaves
accordingly.
❑❑ Expects the client to test her competence and commitment toward the care.
❑❑ Closely observes the client and expects to be observed.
❑❑ Begins to make inferences and forms judgments about client messages and behaviors.
❑❑ Prioritizes the client’s problems and identifies the client’s goals.
❑❑ Clarifies the clients and nurses roles.
❑❑ Forms contracts with the client that specify who will do that.
❑❑ Lets the client know when to expect the relationship to be terminated.
4.3. Working Phase (Exploitation Phase)

In this phase, the nurse and the client work together to solve problems and accomplish care goals.
❑❑ The nurse encourages and helps the client to express feeling about his/her health.
❑❑ The nurse encourages and helps the client with self-exploration.
❑❑ The nurse provides the information needed to understand and change in behavior.
❑❑ The nurse encourages and helps the client to achieve goals.
Chapter 02.indd 27 5/18/2012 11:40:58 AM

1. Preinteraction phase
2. Orientation and identification phase
3. Working phase (exploitation phase)
4. Termination / resolution phase
Figure 2.2 Phases of Interpersonal Relationship
❑❑ The nurse takes actions to meet the goals set with the client.
❑❑ The nurse uses therapeutic communication skills to facilitate successful interactions.
❑❑ The nurse uses appropriate self-disclosure and confrontation with the client.
Sometimes, the nurse may face some barriers to accomplish predetermined goals that are as
follows:
❑❑ Patients may resist to behavioral changes that are necessary to achieve the desired health goals.
❑❑ Patients may conceal or suppress some relevant information.
❑❑ Patients may express excessive liking for the nurse, which is beyond the boundary of the thera-
peutic IPR. Sometimes, patients may express sexual interest in the nurse which is detrimental for
the continuation of the relationship.
❑❑ Sometimes, patients may break appointments and may become silent and sleepy during the inter-
actions with the nurse, which poses difficulty in accomplishing the desired goals.
4.4. Termination or Resolution Phase

During the ending of the relationship, the nurse:
❑❑ Reminds the client that termination is near.
❑❑ Evaluates goal achievement with the client.
❑❑ Reminisces about the relationship with the client.
❑❑ Separates from the client by relinquishing responsibility for his/her care.
❑❑ Achieves a smooth transition for the client to other caregivers as needed (Figure 2.2).
5. BARRIERS IN INTERPERSONAL RELATIONSHIP

Barriers in IPR may develop due to varieties of reasons, some of which are discussed below.
Chapter 02.indd 28 5/18/2012 11:40:58 AM

5.1. Mistrust
Trust is the life blood of any relation whether it is friendship or business or husband–wife relations.
No relationship can last longer, if the persons involved in relationship start losing trust on each other
that will eventually lead to suspicion, hiding information and emotions, and gradually the ending of the
relationship. So, for the initiation and maintenance of IPR, it requires trust between both the persons
involved in a relation.
5.2. Fear of Rejection

Some people don’t/can’t think positive about themselves. They have a preoccupation that the other
person will not accept him/her as a friend or girlfriend/boyfriend. So, the person never tries to initiate
relationship with the other person because it is unacceptable to him/her to be rejected. For example,
fear of rejection can be seen when a person of low socioeconomic status wants to initiate some social
relationship with a person of high socioeconomic status. For example, a person of middle class gener-
ally doesn’t attempt to marry his daughter in an affluent class family because of fear of rejection of his
proposal of marriage by the other party.
5.3. Inflexibility
Inflexibility or rigidity in the way of thinking or acting, or doing things and behaving, may become a
barrier in good IPR. The requirement of good IPR is that the persons involved in relationship should
have flexibility to some extent in accepting the views and way of doing things of each other. If one
partner is consistently showing the rigid behavior, he/she will gradually become unacceptable to other,
and it will cost the relation.
5.4. Lack of Autonomy

Autonomy means freedom to make choices and decisions by someone. Every human being in this
universe likes autonomy in his/her life. If a person feels that his/her partner is not allowing him to be
autonomous and he/she is consistently forcing his/her decisions on her/him without listening to her/his
viewpoints, it will hurt her/his ego and ultimately the health of relationship will be compromised. It
signifies the view that the persons involved in relationship must respect the autonomy of each other; or
else, it may become a barrier in development and continuation of the relationship. Extreme possessive-
ness can be harmful for the relationship.
5.5. Lack of Communication

Good communication between the people is a mandate for the development of good IPR. If at some
point of time, communication is lacking from any side, it may lead to many questions and doubts in the
mind of other person that will definitely jeopardize the growth of good IPR.
5.6. Lack of Respect for the Rights of the Other

Some people have the conscious or subconscious belief that your rights are the only ones that count
in the relationship; therefore, acting in such a way that your partner’s/friend’s/colleague’s rights are
ignored, negated, discounted, or offended may create a barrier in development of IPR.
Chapter 02.indd 29 5/18/2012 11:40:58 AM

5.7. Fear of Intimacy

Some society or culture does not permit intimacy in some type of relationship—for example, girlfriend–
boyfriend relationship in the Indian society. Despite the fact, if one partner unnecessarily tries to inti-
mate the other against his/her wish it will cause fear of rejection by the family and society in the other
partner and he/she starts ignoring the person in relation, leading to disruption of IPR.
5.8. Irresponsible Behavior

A consistent irresponsible behavior shown by either party will act as a barrier in the relationship, be-
cause the other one will feel disheartened and disappointed due to the irresponsibility shown by the
partner.
5.9. Low Self-Esteem

Low self-esteem is the feeling of worthless, being less valuable, with nothing to offer in a relationship.
Low self-esteem is reflected when you either take no initiative in the relationship or you continually
feel inferior, defensive to other partner. It may be taken up negatively by the other partner, leading to
blockage in the progress of your relationship; also it is difficult for a person to initiate a relationship
who has low self-esteem. Therefore, low self-esteem is a significant barrier either in the initiation or
continuation of a relationship.
5.10. Chronic Hostility

Chronic anger may be a result of your high stress background that may lead to bitterness and aggression
toward yourself and others with whom you have some relations. If it persists for a longer time, then
your partner/friend may misread it, take it personally, and feel hurtled, leading to the end of the relation.
5.11. Hiding Feelings

Some people have beliefs that you should never let your partner/friend/colleague know your feelings,
especially, if they are negative or self-deprecating. This belief may be dangerous for your relationship
because it forces the other partner/friend/colleague to always guess what is really going on with you. It
may create suspicion and doubts in other partners, leading to weakened relation.
5.12. Overdependence or Independence

Too much dependence and independence can act as a barrier in IPR. When you show overdependence
on your partner, he/she may take you as a burden and will try to get rid of you. Similarly, if you show
overindependence in your behavior, the other one may lose trust in you and will start suspecting you.
Being overdependent or independent is not good for the health of IPR. One has to maintain balance
between dependence and independence while being in a relationship.
5.13. Chronic Depression

Chronic depression can cause your disinterest in any type of relationship because of the underlying
pathology and slowness of neurotransmission. When the other partner comes to know that you are not
interested or don’t care the relationship in which you are engaged with someone, the other party will
Chapter 02.indd 30 5/18/2012 11:40:58 AM

Mistrust
Lack of Fear of
respect rejecton
Lack of
communication Inflexibility
Barriers
in
Lack of IPR
Low self
Autonomy esteem
Chronic
Irresponsible
depression
behaviour
Fear of Fear of
rejection intimacy
Figure 2.3 Barriers in IPR
also start avoiding you. Chronic depression may not become a barrier in exceptional cases where your
partner is too much devoted to you, but certainly it will reduce the warmth and the enjoyment of being
in a relation (Figure 2.3).
5.14. Barriers in Therapeutic Interpersonal Relationship

Sometimes, therapeutic IPR may get disturbed when the nurse violates professional boundaries of the
relationship. For example, giving and receiving personal gift to and from the patient, sharing personal
intimate secrets with the client, and accepting love proposal from the client are considered unethical and
beyond the boundaries of therapeutic relationship. A nurse must discourage any attempt made by the
patient to get involved personally with the nurse during such therapeutic relationship.
6. H OW TO OVERCOME BARRIERS IN INTERPERSONAL

RELATIONSHIP?
Overcoming the barriers of IPR is the responsibility of both the persons who are engaged in the rela-
tionship. Since there are so many barriers as mentioned above, which may be present in a particular
relationship, the strategies will be different to overcome a particular barrier. The partners are required
Chapter 02.indd 31 5/18/2012 11:40:58 AM

to identify possible barriers and adopt appropriate strategies to save a relation. Given below are some
steps that may be beneficial during the process of overcoming barriers in IPR.
Step 1
Whenever you feel that your relationship is in trouble, try to identify the problem. Sometimes, the
problem may be quite apparent to you, but you may be required to put extra effort in some situations
because you may be totally unaware about the problem. Once you have identified the problem, then list
the consequences that are caused by that problem in your relationship.
Step 2
Write down the problem and its consequences in your relationship on a plain paper so that it will be easy
for you to share it with your partner.
Step 3
Share and discuss the problem/barrier and its consequences in your relationship with your partner/
friend. This discussion with your partner may explore some more barriers about which you were
unaware.
Step 4
On the basis of the discussion carried out in step 3, list the different and similar points of views between
you and your partner. Write down on which points you agree or disagree concerning the barriers and the
consequences of these.
Step 5
Develop a detailed plan of action to address those barriers that exist in your relationship. Try to address
one barrier at a time by answering the following questions:
1. Which type of barrier is it?
2. Can we handle the barrier effectively without the involvement of a third party? If a third party is
required, then decide who will be the most suitable person to act as third party.
3. What type of modification in the behavior of both of us is required to handle the barrier success-
fully?
4. How much time it will take to remove this barrier from your relationship?
5. How we will come to know that the barrier is no longer present in our relations?
6. What actions can be taken to prevent the recurrence of this particular barrier?
Step 6
It’s the time that you have to start working on the detailed plan that was finalized in step 6.
It will help you to restore your relationship.
7. JOHARI WINDOW
American psychologists Joseph Luft and Harry Ingham developed a window of IPR while they were
researching group dynamics. They named this window as Johari window by combining the initial let-
ters of their names (Jo + Har + I). Johari window is widely used to improve communications and to
understand self-awareness, IPR, group dynamics, and team development. The Johari window model is a
simple and useful tool for illustrating and improving self-awareness and mutual understanding between
individuals within a group. The Johari window model can also be used to assess and improve a group’s
relationship with other groups.
Chapter 02.indd 32 5/18/2012 11:40:58 AM

Quadrate I: Open Quadrate II: Blind

Known to self as well known to others Not known to self, but known to others
Quadrate III: Hidden Quadrate IV: Unknown
Known to self but not known to others Not known to self as well as to others
Figure 2.4 Johari Window Quadrants
Johari window is divided into four quadrants according to the facts or behavior or motivations about
which a person may or may not be aware (Figure 2.4).
Quadrant I: Open Area

Quadrant I of the Johari window is known as open or public area. It is also known as the area of free
activity. This quadrant includes all the behaviors and motivations of a person, which are known to him/
her as well as others are also fully aware of these behaviors and motivations. This quadrant is short in
size when you meet someone for the first time in life. When the IPR progresses during the passage of
time, the size of first quadrant continues to increase until both the persons become fully aware of the
behavior and motives of each other.
Quadrant II: Blind Area

Quadrant II of the Johari window is known as the blind area. This area includes all the behaviors, mo-
tives, and other things that are present in a person but the person himself/herself is blind to or unaware
of them. However, these motives and behaviors of the person are well perceived by other people.
Quadrant III: Hidden Area

Quadrant III of the Johari window is known as the hidden or avoided area. It includes all the behaviors,
motives, and other things about which a particular person is fully aware; however, he/she doesn’t reveal
or disclose it to others. For example, this quadrant may include a hidden agenda or some sensitive mat-
ters which a person conceals from others.
Quadrant IV: Unknown Area

Quadrant IV of the Johari window is known as the unknown area. It includes the areas of unknown
activity, in which neither the individual himself/herself nor others are aware of certain behaviors or mo-
tives about him/her. Yet, their existence can be assumed because some of these behaviors and motives
influence the IPR without the notice of both parties.
It is quite interesting to know how the size of these quadrants are increased or decreased when a new
group is formed.
Whenever a new group is formed, the group members are not much more knowledgeable about the
behaviors and motives of each other. Therefore, the first quadrant is very small in this initial step of
new group formation. As the group grows and matures, people start interacting with each other, which
leads to the expansion of quadrant I in size. Quadrant III shrinks in area as quadrant I grows larger, be-
cause quadrant I will occupy the space of quadrant III; therefore, there will be less things about which
the other group members are not aware. When the trust is developed between group members due to
continuous interactions, they find it less necessary to hide or deny things they know or feel. In an at-
mosphere of growing mutual trust, there is less need for hiding pertinent thoughts or feelings. It takes
longer for Quadrant II to reduce in size, because usually there are “good” reasons of a psychological
Chapter 02.indd 33 5/18/2012 11:40:58 AM

I II
IV
III
Figure 2.5 Johari Window (New Member in a Group)
nature to blind ourselves to the things we feel or do. Quadrant IV is larger and has more influence in an
individual’s relationship than the hypothetical sketch illustrates.
When a new person enters into a group, the size of various quadrants can be represented by the
Figure 2.5.
The open area is small in size because others know little about the new person; also, the person
himself/herself may not be aware about the motives he/she has in the group. Similarly, the blind area is
small because others know little about the new person. The hidden area that includes avoided issues and
motives is a relatively large area. When the person gradually mixes up with the group and builds IPR,
the size of the open area increases because people come to know about the behavior, motives, and other
things about a person. When the person has developed good IPR with the other members of the group,
the size of various quadrants of the Johari window will be as given in Figure 2.6.
The open free region is large because others know a lot about the person than the person also knows
about himself/herself. Through the processes of disclosure and receiving feedback, the open area has
expanded and at the same time the sizes of the hidden, blind, and unknown areas are reduced.
I II
IV
III
Figure 2.6 Johari Window Quadrants (New Member Developed Good IPR in a Group)
Chapter 02.indd 34 5/18/2012 11:40:58 AM

8. P RINCIPLES OF CHANGE IN THE SIZE OF QUADRANT WITHIN

THE JOHARI WINDOW
❑❑ A change in any one quadrant will affect all other quadrants.
❑❑ Energy is required to hide or to be blind to the motives that are involved in interaction.
❑❑ Interpersonal learning refers to changes that increase the size of quadrant I and reduce the size of
one or more quadrants.
❑❑ The size of first quadrant is directly proportional to the communication. The smaller the
first quadrant, the poorer the communication and the larger the first quadrant the better the
communication.
❑❑ There is universal curiosity about the unknown area; but this is held in check by custom, social
training, and diverse fears.
9. LIMITATIONS OF THE JOHARI WINDOW

❑❑ Few things are perhaps better not communicated (sexual behavior, mental health problems, or
large-scale failures).
❑❑ Some people may pass on the information they received further than you desire.
❑❑ Some people may react negatively.
❑❑ Using the Johari window is a useless exercise if it is not linked to activities that reinforce positive
behavior or that correct negative behaviors.
10. H ARRY STACK SULLIVAN INTERPERSONAL

RELATIONS THEORY
Psychiatrist Harry Stack Sullivan is the originator of interpersonal relations theory. The theory em-
phasized that the essence of being human is the capacity to live effectively in relationship with oth-
ers. IPR is a relationship between two or more persons that result in a mutual or reciprocal action
or influence. In his interpersonal theory, Sullivan believed that such a relationship has the power to
transform an immature preadolescent into a psychologically healthy individual. All personal growth,
personal damage, and regression are a result of our relationships with others. Failures to develop IPRs
are responsible for mental illnesses. This theory points out that personality development depends on
the IPR one individual has with another. Sullivan described the basic principles of the interpersonal
theory, which are as follows:
❑❑ Development of a person proceeds through various stages; different patterns of relationship are
involved in each stage.
❑❑ If a person fails to make satisfactory progress through various stages, it may result into a maladap-
tive behavior.
❑❑ For example, an infant or preschooler likes to interact with parents because there is need for con-
tact and security. Similarly, in the stages of preadolescence and adolescence, there is a gradual
withdrawal of the child from parents; peer relationship becomes more important. During early
adulthood, intimate relationships with heterosexual groups are established, resulting in a marital
setting.
Chapter 02.indd 35 5/18/2012 11:40:59 AM

CHAPTER HIGHLIGHTS
❑❑ IPR: It can be simply defined as a relationship that exists between two or more persons to fulfill
some goals or to satisfy the needs of each others.
❑❑ People in a relationship tend to influence each other, share their thoughts and feelings, and engage
in activities together. Because of this interdependence, most things that change or impact one
member will have some level of impact on the other member in relation.
❑❑ George Levinger proposed five steps of development of IPR, which are acquaintance, buildup,
continuation deterioration, and termination.
❑❑ The purpose of therapeutic IPR is to facilitate communication of concerns, thoughts, feeling, and
anxiety between the patient and nurse.
❑❑ Relations may be of various types, depending on the purpose and needs of the people.
❑❑ Hildegard E. Peplau was the first person in the field of nursing who did significant work on
IPR.
❑❑ Phases of IPR are preinteraction phase, orientation phase, working phase, and termination phase.
❑❑ Mistrust, fear of rejection, lack of communication, lack of respect for rights of others, and irre-
sponsible behavior is some of the barriers of IPR.
❑❑ American psychologists Joseph Luft and Harry Ingham developed a window of IPR; they named
this window as Johari window.
❑❑ Johari window is divided into four quadrants according to the facts or behavior or motivations,
which a person may or may not be aware about him.
❑❑ The first quadrant of the Johari window is known as open or public area, the second quadrant of
Johari window is known as blind area, the third quadrant of Johari window is known as hidden or
avoided area, the fourth quadrant of Johari window is known as unknown area.
❑❑ A change in size of any one quadrant of the Johari window will affect the size of all other quad-
rants.
❑❑ Psychiatrist Harry Stack Sullivan is the originator of interpersonal relations theory. The theory
emphasized that the essence of being human is the capacity to live effectively in relationship with
others.
EVALUATE YOURSELF
Q 1: According to Levinger, which one of the following is not a step of development of interpersonal
relationship?
(a) Initiation
(b) Acquaintance
(c) Continuation
(d) Deterioration
Q 2: Which one of the following is a particular type of relation in which termination of the relationship
is essential and preplanned?
(a) Therapeutic interpersonal relationship
(b) Husband–wife relationship
(c) Social relationship
(d) Business relationship
Chapter 02.indd 36 5/18/2012 11:40:59 AM

Q 3: Most of therapeutic work is carried out in which phase of therapeutic relationship?

(a) Introductory phase
(b) Exploitation phase
(c) Resolution phase
(d) Termination phase
Q 4: Quadrate III of the Johari window is also known as ___
(a) Public area
(b) Avoided area
(c) Unknown area
(d) Blind area
Q 5: Johari window was developed by ___
(a) Leninger and Parker
(b) Jackon and Hassy
(c) Joseph and Harry
(d) Julia and Harrison
Q 6: Define therapeutic interpersonal relationship and explain the phases and barriers of IPR
(NTRUHS, 2010).
Q 7: Write how to establish effective interpersonal relations with patients in your clinical settings
(BFUHS, 2007, PB BSc).
Q 8: Explain the importance of human relations in nursing (BFUHS, 2006, PB BSc).
Q 9: Explain the barriers of interpersonal relationship and methods to overcome the barriers in inter-
personal relationship (NIMS, 2008; RUHS, 2010).
Q 10: Write a short note on Johari window (BFUHS, 2010; NIMS 2010).
1. Berscheid E., Peplau L.A. (1983). “The emerging science of relationships”, New York:
W.H. Freeman and Company.
2. Levinger G. (1983). “Development and change”, New York: W.H. Freeman and Company.
3. Gable S.L., Reis H.T., Impett E.A., Asher E.R. (2004). What do you do when things go right?
The intrapersonal and interpersonal benefits of sharing positive events. Journal of Personality and
Social Psychology, 87, 228–245.
4. Maniaci M.R., Reis H.T. (2010). The marriage of positive psychology and relationship science:
A reply to Fincham and Beach. Journal of Family Theory & Review, 2, 47–53.
Chapter 02.indd 37 5/18/2012 11:40:59 AM

c h a p t e r 3
Human Relations
1. INTRODUCTION
In the present scenario of technical and modern advancement, human relation skills are very essential to
bring about productivity, work culture, essence of responsibility, and accountability. This has extended
from industry and commerce to these professions, which deal more directly with human beings and their
welfare. Nursing, medicine, social work, and psychology are some of them.
For better performance of nurses as a professional, good citizen, and as a member of health
care team, she should be skilled in the Sciences of Human Relations and Communications,
which will enable her to understand human behavior and develop a positive attitude toward the
profession.
2. HUMAN RELATION
Human relation refers to the science of applying principles of social psychology in improving the work-
ing of an organization and to make it more productive and the worker happier to improve efficiency and
job satisfaction.
In industrial setting, human relations means the systematic body of knowledge used to explain the
behavior of people at work.
According to Keith Davis, “Human relations is an area of management practice which is concerned
with the integration of people into a work situation in a way that motivate them to work productively,
cooperatively and with economic, psychological and social satisfaction.”
2.1. Characteristics of Human Relations

❑❑ Human relations are an integrative process through which the goals of a group and the motives of
the people working in an organization are harmonized.
❑❑ Human relations are an interdisciplinary field. It involves the use of knowledge from sociology,
psychology, anthropology, and other science for the study of human behavior.
❑❑ Human relations recognize the dignity of the individual as a human being.
❑❑ Human relations are an action-oriented approach to build human cooperation toward predefined
goals.
Chapter 03.indd 38 5/18/2012 11:41:30 AM

Human Relations | 39
2.2. Importance of Human Relations

Human being, by virtue of his/her social nature, requires some relations to achieve the aims of social,
personal, and professional life. The importance of human relations is different in various spheres of hu-
man life. Generally, they are as follows:
❑❑ Good human relations within the organizations bring a sense of belongingness among coworkers.
❑❑ Good human relations boost the morale.
❑❑ Good human relations increase productivity and improve coordination among coworkers.
2.3. Factors for Establishing Cordial Human Relations

In an organization, the determinant factors of cordial human relations are:
❑❑ Common goals
❑❑ Group cohesiveness
❑❑ Inter-relatedness of personality
❑❑ Caring organizational policy
❑❑ An effective communication system
❑❑ Mutual trust and understanding in organizational culture
❑❑ Motivation and greater human understanding
3. UNDERSTANDING SELF
We are not born with the understandings. At birth, we have no idea that we are a separate being. Soci-
ologists emphasize that we become aware of ourselves as individuals through our participation in the
social environment.
George Herbert Head (1964): The self represents the sum total of people’s conscious perception of
their own identity as distinct from others. It is not a static phenomenon, but continues to develop and
change throughout our lives.
Gardner Murphy: The self of a person is what he/she consciously or unconsciously concerns him-
self/herself to be. It is the sum total of his/her perceptions of himself/herself and especially his/her at-
titudes toward himself/herself. It is his/her “self-concept.”
Cooley: By self is meant that which is designated commonly by “I” means myself.
3.1. Development of Self

The concept of being “self” is developed throughout the life of a person. A child develops the concept of
“self” as being male or female. Thereafter, gradually he/she develops concepts of being white or black,
tall or short, intelligent or poor based on the comments made by significant others. A person continu-
ously strives to know: who am I? From where did I come? Why did I take birth as human being? Before
taking birth where I was? These are few questions that a person tries to answer during his/her lifetime.
3.1.1. Cooley’s Concept of “Looking-Glass Self”

The term “looking-glass self” was coined by Cooley after extensive psychological testing in 1902 to ex-
plain the concept of self-development. According to this concept, social interaction plays an important
role in the development of self. A person forms the concept of himself/herself on the basis of opinion
Chapter 03.indd 39 5/18/2012 11:41:30 AM

and views expressed by others about him/her. Therefore, when our friends, teachers, parents, and sig-
nificant others express their opinion about us as intelligent or poor, tall or short, fat or thin, we accept
and form the same opinion about ourselves. It is just like a mirror tells us about our physical self, and
the perception of that provides an image of our social self.
Cooley proposed three principal elements of the looking-glass concept:
1. Our perception of how we look at others.
2. Our perception of their judgment of how we look, and
3. Our feelings about these judgments.
3.1.2. Mead Theory of I and ME

Mead’s theory explains that self develops out of the child’s communicative contact with others. The
process of socialization develops the “self” of a person. Our capacity to see ourselves through others
implies that the self has two components. It can be both subject (I) and object (Me). When the process
of socialization is initiated through social action, the “self” operates as a subject (I); thereafter, as we
take the role of the other the self operates as an object (Me). All social experience has both components:
we initiate an action (I phase of self) and then we continue to action, based on how others respond to us
(Me phase of self). Thus social experience is the interplay of the I and ME.
Lewis (1993) described five aspects of the self that are the physical self, the private self, the social
self, the spiritual self, and the self-as defined-by others. The physical self is composed of biographic
details and the image of oneself, the private self is the self that is not shown to others, the social self is
that part of the self that is shown to others, and the spiritual self is the aspect of the self that searches
for personal meaning and tries to make sense of what is happening. The self-as-defined-by others is the
way in which others see us.
4. SOCIAL BEHAVIOR
Social behavior is the behavior of a person that is directed toward society or takes place between mem-
bers of the society. Social behavior of an individual in a group is called group behavior. Group activity,
group discussion, group opinion, and group reaction are common psychosocial events in a society, and
all these social interactions are known as collective behavior. For example, the prayers at a church or
temple and celebration of Christmas may be called collection behavior. Person’s activities are regulated
by custom, law, and social obligation. Social behavior is a process of communication between the mem-
bers of the society in social context. In a sociological hierarchy, social behavior is followed by social
actions, which is directed at other people and is designed to induce a response.
4.1. Factors Influencing Social Behavior

Social behavior is governed by social norms, customs, value, and traditions that are transmitted from one
generation to other. Other than social norms and traditions, our motives, drives, and ambitions are also re-
flected in our social behavior. Normal social behavior is necessary for social harmony. Whenever some-
one violates social norms and behaves against the established social values and traditions, it is termed as
antisocial behavior. Social behavior develops and matures in a child as a process of socialization gov-
erned by various social agencies like father, mother, friends, colleagues, and various social and religious
groups. The primary agency of socialization, that is, parents, initiates the process of socialization that is
further influenced by peers and social groups (secondary agency), which determine the social behavior
Chapter 03.indd 40 5/18/2012 11:41:30 AM

of an individual because these social agencies serve as a connecting link between an individual and the
society. Social groups to which an individual belongs can also affect his/her motives, control, and drives.
The way men behave is largely determined by their relation to each other and by their membership
in groups. Culture also plays a central role in the development of social behavior of an individual by
determining the rituals, traditions and values, way of talking or greeting to other, clothing, and many
more to add in the list. These rules and regulations that differ from one culture to other explain why
social behavior of a particular group of persons is distinct from others.
In conclusion, social behavior of a person is determined by his/her way of interaction, gestures, and
postures which is influenced by his/her membership to various groups, peers, and more importantly
the primary group or primary relatives (parents and family members) that connect the individual to the
society and determine his/her motives, impulsivity, and control.
Social life is a system of well-structured and stable relationship. A society must have harmony and
an order to survive that is characterized by change rather than stability, uncertainty rather than predict-
ability, and disorganization rather than equilibrium. This aspect of social life in sociology is known as
collective behavior.
4.2. Drives
Drive may be defined as an aroused awareness, tendency, or a state of heightened tension that sets off
reactions in an individual and sustains them for increasing his/her general activity level. The drive starts
within the individual and directs him/her in such a way that may bring about the satisfaction of that
need. The strength of a drive depends upon the strength of the stimuli generated by the related need.
Drives are generally divided into two categories: the primary or the biological drive and secondary or
sociopsychological drives.
Primary drives are related with biological system of our body such as hunger, thirst, escape from
pain, and sex. The biological drives are unlearned in nature and rise from biological needs as a result of
a biological mechanism called homeostasis.
Secondary drives are psychosocial in nature such as anxiety, fear, desire for approval, struggle for
achievement, aggression, etc. These drives are not related to physiological needs of a person and there-
fore do not arise from imbalances in the harmony of internal functioning of the body. Rather, they arise
from sociopsychological needs and are acquired through social learning as a result of one’s interaction
with the sociocultural environment. These drives move an individual to act for the satisfaction of social
and psychological needs and to reinforce the behavior to be maintained and continued.
W.B. Cannon, a prominent Harvard University physiologist, suggested that our body system works
constantly toward optimum level of functioning, thus maintaining a normal state of balance between
input and output. For example, when the blood sugar level drops, the brain, glands, stomach, etc. send
out signals to activate the hunger drive and makes one feel hungry. Once food has been consumed by
the individual, it returns to a state of balance. The maintenance of this overall physiological balance is
termed as homeostasis.
The term homeostasis as used by Cannon can be broadened to include any behavior that upsets the
balance of an individual. The denial or failure in the satisfaction of any basic need may give rise to an
imbalanced physiological state, thus giving rise to a primary or secondary drive.
4.3. Incentives
Drives are influenced by incentives, appreciation, rewards, fulfillment of one’s need, and achievement
of the desired objective.
Chapter 03.indd 41 5/18/2012 11:41:30 AM

Incentive refers to the motivational value of reinforcement. Without an incentive, an individual can-
not be motivated. Incentive can be positive or negative and may be material, semimaterial, or nonmate-
rial. It can also be verbal, nonverbal, biological, or social.
4.3.1. Motivation
Motivation is derived from the Latin word “movere,” which means to “move” or “to energize,” or “to
activate.” It is a process that arouses energy or drive in the individual to engage in an activity. The activ-
ity is aroused, fulfills the need, and reduces the drive of tension.
Motivation is often used to refer to an individual’s goals, needs, and intentions. For example, when
one is hungry, the need is food, and it induces drive. When the food is searched and consumed, the
hunger drive is reduced.
All human behavior is motivated by something. Very little human behavior is completely random
or instinctive. People do things for some reason to get certain results, and thus behavior is relatively
predictable.
Concept of Motivation
The four components of motivation are need, drive, response, and goal. For example, when you feel
thirst, there is a need for water because your earlier intake of water is consumed up. Thirst, a drive, will
motivate you to search for water. This drive caused you to respond with some action that, in this case,
will be looking for water and the actual drinking of water will become your goal. Once you had reached
your goal by drinking enough water, your motivation to rummage around for water will vanish and your
need for water will be satisfied for the time being. When you become thirsty again, you will go through
the same motivation cycle again.
Virtually today, all scholars have their own concept of motivation and include terms like motives,
needs, wants, drives, wishes, etc. in defining motivation. In order to understand the concept of motiva-
tion, we need to understand the following terms:
Motives: Motive has been defined as “An inner state that energizes, activates or moves a person and di-
rects his behaviour towards goals achievement.” According to Rosen Fox and Gregory, “motive is a readi-
ness or disposition to respond in some ways to a variety of situations.” It is restlessness, a lack, and a force,
which energizes the organism to do something to reduce restlessness and to mitigate the force (Figure 3.1).
Motivating: It is a term which implies that one person in the social context induces another to engage
in action by ensuring that a channel to satisfy the motive becomes available and accessible to the indi-
vidual. For example, in school/college, a teacher stimulates and channelizes the student-nurse to reach
academic goal (Table 3.1).
Motive Motivating Motivation
Activating needs and

Needs in Engagement in
providing needs
individual action behaviour
satisfaction enviornment
Figure 3.1 Concept of Motivation
Chapter 03.indd 42 5/18/2012 11:41:30 AM

TABLE 3.1 Types of Motives

Primary or basic needs or Secondary or social or
biological motives Stimulus motive learned motives
Hunger Activity Power

Need for sleep Curiosity Achievement
Avoidance of pain Manipulation Affiliation
Thirst Physical contact Aggression
Elimination of waste
Sex
Motivation: While a motive is the energizer of action, motivation is action behavior itself. Motivation
depends on motives and motivating; therefore it becomes a complex process.
Mc Farland refers motivation to the way in which urges, drives, desires, aspirations, strivings, or
needs direct, control, or explain the behaviors of human beings. Motivation involves a chain reaction
starting out with felt needs giving rise to tension (unfulfilled desires), thereby causing action toward
satisfying wants.
Definition of Motivation
Motivation refers to the driving and pulling forces that result in persistent behavior directed toward
particular goals.
According to Young, “Motivation is the process of arousing the action, sustaining the activity in
process and regulating the pattern of activity.”
According to Morgan and King (1975), “Motivation refers to the states within a person or animal
that drives behavior towards some goals.” Motivation refers to all the internal conditions that stir up
activity and sustain activity of an individual.
The Motivation and Behavior
Motivation is considered as one of the most important factor affecting human behavior and perfor-
mance. Let us see how it regulates our behavior.
❑❑ Feeling of need by an individual generates a feeling that he/she lacks something (unsatisfied
needs).
❑❑ Lack of something creates tension in the mind of individual (tension).
❑❑ Tension is not an ideal state of mind. An individual tries to overcome this by engaging himself/
herself (search behavior).
❑❑ Behavior through which he/she satisfies his/her need (satisfied need). This is goal-directed be-
havior.
❑❑ When the individual succeeds in fulfilling his/her need and thereby overcoming his/her tension in
the favorable environment (reduction in tension).
❑❑ Satisfaction of one need leads to feeling of another need, which might be the same after a lapse
of certain period.
Psychologists have tried to explain the process and mechanism of motivation in a number of ways.
Lets us see some important theories of motivation.
Chapter 03.indd 43 5/18/2012 11:41:31 AM

5. THEORIES OF MOTIVATION
5.1. McDougall’s Theory of Instinct
William James for the first time brought out the concept of instinct to explain behavior and how and
why we behave in a specific manner in a specific situation, but the credit for developing it into a full-
fledged theory goes to William McDougall.
According to McDougall’s theory of instinct, our instincts are the springboards of our behavior.
These instincts are innate tendencies or inherited psychological dispositions or even the complex pat-
terns of behavior that lead to some purposive actions and need not to be learned.
The theory proposes that all human behavior can be explained on the basis of some instinct or may
be accompanied by a specific emotional disposition. For example, the instinct of escape is accompanied
by the emotion of fear; similarly, the instinct of combat is accompanied by anger, the instinct of repul-
sion by the emotion of disgust, and so on. The theory further claims that all behavioral acts that are es-
sentially instinctive has three aspects: (a) cognition (knowing), (b) affection (feeling or experiencing an
emotion), and (c) conation (doing or striving). For example, when a person sees a lion coming toward
him/her, he/she recognizes the danger (cognitive), experiences an emotion of fear, and tries to run away
(conation).
The theory of instinct has been a subject of great controversy and criticism by sociologists and an-
thropologists who have emphasized that human is not purely instinctive and his/her basic nature is not
an animal nature. Therefore, human behavior is not an instinctive behavior but is definitely shaped by
the forces of his/her social and cultural environment, which further explains why behavior of two indi-
viduals is not the same at a given time for the same instinct.
Researches done in the field of cognitive ability have clearly revealed that behavior in which the
higher intellectual faculties (thinking, reasoning, and problem-solving behavior) are involved cannot be
explained in terms of instinctive behavior.
In spite of all the criticism leveled against it, the instinctive theory as a theory of motivation has not
altogether lost ground and is still regarded as an important theory to explain the why-and-how of human
behavior.
5.2. Hull’s Drive Reduction Theory of Motivation

Clark Leonard Hull (1943), a psychology professor at Yale University, developed a theory of motivation
known as “drive reduction theory.” This theory emphasized that biological drives such as hunger, sex,
and escape from pain produce internal tension (an undesirable state that the organism wants to change),
and all of his/her energy is concentrated on his/her efforts to reduce the heightened tension (drive).
This theory is also supported by other psychologists, and its sphere was broadened by including the
psychological drives in it. However, the theory failed to explain human behavior especially at the higher
cognitive level, which reduced its importance as a major motivational theory.
5.3. Freud’s Psychoanalytic Theory of Motivation

Freud’s psychoanalytic theory of motivation is centered on his concepts of instincts and the uncon-
scious. Freud maintained that instincts are the root cause of all behavior or activities in a human being.
He identified two basic instincts for this purpose, that is, the life and death instinct. The life instinct,
the urge for self-preservation, dominates the earlier scenes of one’s life. When the life instinct ceases to
operate, the death instinct takes over. For example, the person who has failed in a love affair may think
Chapter 03.indd 44 5/18/2012 11:41:31 AM

of committing suicide. However, the need for sexual gratification moves or energizes on the activities
of the life instinct, thus providing meaning to one’s life.
Besides the life and death instincts and the sexual urge, the unconscious is also a great determinant and
activating force for the cause and operation of one’s behavior. Man, as Freud maintains, is a puppet in the
hands of the mighty unconscious dictates. Therefore, the key to the why-and-how of behavior lies in the
choices made by one’s unconscious, which are usually the gratification of sex or the seeking of pleasure.
5.4. Adler’s Social Urge Theory of Motivation

Alfred Adler, a student of Freud, advocated that human beings are motivated primarily by social urges
not by sex urges only as advocated by Freud. For maintaining one’s social self, one requires a margin
of safety besides simple security in terms of protection from danger. This safety margin is achieved
through domination and superiority. In order not to feel inferior or small, one strives or struggles for
superiority. Therefore, the struggle for power, achievement, and status or the will to dominate are re-
ally an outgrowth of the fundamental need for security. Thus, the motivation of human behavior may
be endorsed through a single basic motive known as the security motive to maintain one’s social cell.
5.5. Behaviorist Learning Theories of Motivation

Pavlov, Watson, and B.F. Skinner were the great advocate of behaviorist theory of motivation. They
emphasized that many times our behavior is guided through a simple stimulus response mechanism or
operated through the mechanism of classical or operant conditioning. Skinner’s theory of operant con-
ditioning emphasized the role of reinforcement as a prime factor for the motivation of behavior.
Albert Bandura (1977), a social learning theorist, maintained that human motivation is mainly guid-
ed through social rewards like praise. Thus, a boy who is often praised for his skill in drawing will
become a good artist. According to him, if the initiation of others behavior results in a reward provides
a valuable motivational source for most of us.
5.6. Goal-Oriented Theory of Cognitivism

The cognitive view of motivation was first propounded by the philosopher and psychologist William
James (1842–1910). Unlike the mechanistic and instinctive approaches adopted by other psychologists,
the cognitive school of psychology brings the role of cognitive factors in producing human motivation
into the limelight. According to this view, human behavior is purposeful and has a certain end or goal
in view. An individual who desires to reach a goal is helped by his/her cognitive abilities to develop a
desirable drive or motive, i.e., tendency to move toward that goal. The achievement of the goal satisfies
the individual, which in turn reinforce the maintained behavior. For example, information regarding the
link of smoking with heart diseases and cancer creates dissonance in chain smokers. They cannot resist
the temptation to smoke even though they are warned that cigarette smoking is injurious to their health.
Thus, there is an imbalance involving the cognition and behavior. The remedy lies in goal-directed be-
havior that is aimed at reducing the imbalance either by stopping the excessive smoking or by refusing
to believe the information of associated danger.
5.7. Maslow’s Self-Actualization Theory

Abraham Maslow (1908–1970) proposed that a motivational behavior can satisfy many needs at the same
time. Human needs according to Maslow arrange themselves in hierarchies of prepotency. In other words,
Chapter 03.indd 45 5/18/2012 11:41:31 AM

Self
actualization
Extreme needs
Belonging and love needs
Safety needs
Physiological needs
Figure 3.2 Maslow’s Hierarchy of Needs
the appearance of one need generally depends on the satisfaction of the others; they are closely related to
each other and can be arranged from the lowest to the highest development of the personality (Figure 3.2).
The physiological needs necessary for survival are at the bottom of the structure, whereas distinctly
psychological needs are at the top. Starting from the satisfaction of the physiological needs, every indi-
vidual strives for the satisfaction of the other needs of a higher order. This striving for one or the other
level of needs provides the motivation for his/her behavior. A need that has been satisfied can no longer
act as motivating force. It ceases to be a motivating force, and therefore the satisfaction of one need
leads the individual to try for the satisfaction of other needs. In other words, the motivational behavior
of a person is always dominated by his/her unsatisfied wants, desires, and needs.
But there is room for exception in Maslow’s hierarchy of needs to explain human motivation. It ap-
pears that the effects of the gratification of a need are more stimulating and important than the effects of
deprivation. The gratification of needs of the lower order motivates an individual to strive for satisfaction
of needs of the higher order, but there may be exceptions to the hierarchical order. One may be more mo-
tivated for the satisfaction of one need at the cost of another. Hence, the need of self-actualization domi-
nates and rules all the order lower level needs. The fulfillment of self-actualization is thus a must for an
individual as he/she will feel discontented and restless unless he/she strives for what he/she is fitted for.
6. SOCIAL ATTITUDE
Attitude refers to certain regularities of an individual’s feelings, thoughts, and predispositions to act
toward some aspects of his/her environment.
Thurstone defined attitude as “the sum total of a man’s inclination and feelings, prejudices or bias,
preconceived notions, ideas, fears, threats, and convictions about any specific topic.”
Thomas described attitude as “the state of mind of the individual toward a value that may be love of
money, desire for fame, and appreciation for God.”
Chapter 03.indd 46 5/18/2012 11:41:31 AM

Bernard defined it as “An attitude is essentially an in-completed or potential adjustment behaviour

process. It is the set of the organism toward the object or situation to which an adjustment is called for.”
Beliefs are usually integrated with social attitudes (Rokeach, 1973) because beliefs whether reli-
gious, economic, and political are strongly knotted with an individual’s opinions. For example, attitude
toward AIDS is related with beliefs about this disease. Thus, social attitudes create individual differ-
ences in ideology within a society.
6.1. Characteristics of Attitude

❑❑ The attitude is orientation of the organism to the world of objects.
❑❑ The existence of an attitude involves a certain amount of tension, even where it is latent. In this
respect, it probably differs from habit or any other form of behavior.
❑❑ Attitudes are rooted in experience, which determines the character of an attitude, its direction, as
well as intensity.
❑❑ Attitudes are expressive, communicable, and under certain circumstances contagious.
One of the important features of attitude is that it is not static rather it is a dynamic process with fluid-
ity, which evolves and changes throughout the life. For example, if a person is having negative attitude
toward HIV/AIDS, it doesn’t mean that the attitude of that person will remain permanently negative
toward HIV/AIDS. It may be changed over the time when the person acquires more knowledge about
the area concerned. This characteristic of attitude has implication for Nursing Profession as nurses have
to deal with the health-related attitude of the patients and society.
Nurses conduct health education and public awareness campaign and use mass media so that the at-
titude of the society can be changed toward some issues concerned with their health-related practices.
For example, attitude of the society can be changed toward female feticide, HIV/AIDS, tuberculosis
and leprosy. In a society, our social relationship involves an adjustment of attitudes with each other. A
person changes his/her attitudes to adjust himself/herself with other individuals. Similarly, a person at
a given time may be a friend of the other while after some time he/she may turn into his/her enemy.
Social attitudes reflect how a group of people or society reacts toward some objects, situations, other
social groups, and person. For example, the social attitude of the typical Indian society is that nonveg-
etarian foods should not be eaten by human beings, girls should not be sent to school for education, and
early marriage should be encouraged to prevent promiscuous sexual behavior by the teenagers and adult.
Social attitude of a person is influenced by a number of factors (e.g., parents, social groups, work
group, peers, culture, ethnicity, IQ level, etc.). It begins to develop in early childhood and that is why
it is emphasized for the parents and school teachers that they should “teach attitude first” to their chil-
dren. Parents are advised to be role model of the child because attitude is communicable and contagious
and the child develops attitudes toward a number of things by observing the behavior of their parents.
Similarly, health care professionals and nurses should act as role model to develop the desired health
care attitude among the society or patients. For example, when the nurse show caring attitude toward
HIV/AIDS or tuberculosis patients, it changes the attitude of other patients and family members toward
these illnesses.
Lawrence K. Frank explained the development of attitude in a child. The young child strives to
achieve tensional adjustment by reacting to the objects and people when he/she encounters them in his/
her environment. Each such reaction results in a tensional change or attitudinal change in a child. This
attitudinal change becomes relatively permanent with the recurrent subsequent exposure to the same
object or person in the environment.
Chapter 03.indd 47 5/18/2012 11:41:31 AM

Thereafter, in a novel situation, the child will learn to respond selectively by ignoring whatever is
incongruent with the already developed attitude. These experiences are cumulative, which provides a
shape to the attitude and personality of the child.
It is necessary for social changes to take place so that, attitudes of the individuals can be changed. The
changing attitudes of the individuals in any community are indicative of changes in social institutions.
7. INDIVIDUAL AND GROUP

The individual is a part or unit of the society. Society is constituted by the groups of people, and each
group is the aggregation of the individuals. So, the fabric of the society is prepared of threads of in-
dividual. There are some theories that explain the concepts of individual and society. Social contract
theory assumes that, individual is born independent but in his/her association with others, he/she makes
mutual bargain and enters into a contract. Society is that system of contracts made by the individuals
with each other. On contrary, biological theory tries to explain the concept of individual and society by
comparing it with the human body. If the society is considered as a human body, then the individual will
be considered as a cell that constitutes the whole body (society). The individual identifies himself/her-
self with the group, but his/her individuality is not lost by being a part of the group. Cooley maintained
that primary group is the nurseries of human nature because it develops the personality of a person. The
primary group is the main link between individual and the society. It provides him/her emotional sup-
port that binds him/her to the group and through it to the aims of larger society. The individual derives
an image of himself/herself from the primary group.
A group is collection of two or more people who have a relationship with each other, are interde-
pendent, may have common norms/purposes, and work face to face on a task that require cooperation.
Given below are definitions of a group proposed by sociologists.
7.1. Definitions of Group

Thompson: A social group is “a number of people coming together, sharing some purpose, interest or
concern and staying together long enough for the development of relationship which includes them all.”
Williams: A social group is “a given aggregate of people, playing inter-related roles and recognized
by themselves or others as a unit of interaction.”
Ogburn and Nimkoff: “Whenever two or more individuals come together and influence one another
they may be said to constitute a social group.”
Sheriff and Sheriff: “A group is a social unit which consists of a number of individuals who stand in
definite status and rare relationships to one another and which possesses a set of values or norms which
regulate own regulatory the behaviour of individual members at least in matters of consequence to the
group.”
7.2. Characteristics of Group

From the above-mentioned definitions, some common characteristics of a group can be listed as follows:
1. Each group has its own identity and structure.
2. Each group includes at least two or more people.
3. Each group has a shared purpose or goal.
4. Group members have a conscious identification with each other.
Chapter 03.indd 48 5/18/2012 11:41:31 AM

5. Group members need the help of one another to accomplish the purposes for which they are
organized.
6. Group members interact, communicate, and influence each other.
7. Every group has its own rules or norms, which the members are supposed to follow.
7.3. Classification of Social Group

The following section provides some of the important classification of social groups proposed by some
prominent sociologists.
7.3.1. Cooley’s Classification of Social Groups

Cooley classified the social groups into primary and secondary group on the basis of the kind of contacts
group members have with each other.
Primary group: Primary group is considered as a nucleus of all social organization. It is the type of
social group in which there is face-to-face, intimate, direct, and personal relationships among the group
members. For example, family is a primary group.
Secondary group: Secondary groups are those in which the relationships between the group mem-
bers are impersonal, indirect, and secondary. Ogburn defined secondary group as “the groups which
provide experience lacking in intimacy.” For example, Indian National Congress, Bharatiya Janata
Party, Trained Nurses Association of India, and Nursing Research Forum of India are some of the sec-
ondary groups.
7.3.2. F.H. Gidding’s Classification of Social Group

Gidding classified the social groups into two types: genetic and congregate group.
Genetic group: Genetic group is a social group whose membership is involuntary and is determined
by genetics. For example, family is a genetic group and its membership is involuntary.
Congregate group: It is social group whose membership is voluntary; anyone who wishes to be a
member of congregate group can join this type of group.
7.3.3. Dwight Sanderson’s Classification of Social Group

He classified social groups into three types on the basis of group structure: involuntary, voluntary, and
delegate groups.
Involuntary group: It is based on kinship such as the family. A man has no choice to what family
he will belong.
Voluntary group: It is one in which a man joins of his own wish. He agrees to be a member of it and
is free to withdraw at any time from its membership.
Delegate group: It is one in which a man join as a representative of a number of people either elected
by them or nominated by some power. For example, Parliament of India is a delegate group.
7.3.4. George Hasen’s Classification of Social Groups

George Hasen classified social groups into four types on the basis of their relations to other groups.
Accordingly, social groups are classified into unsocial group, pseudosocial group, antisocial group, and
prosocial group.
Unsocial group: It is a group which largely lives for itself. Group members do not participate in the
larger society of which the group is a part. It does not mix up with other groups and remains isolated
from them.
Chapter 03.indd 49 5/18/2012 11:41:31 AM

Pseudosocial group: It participates in the larger social life but mainly for its own gain and not for
the greater good.
Antisocial group: It is the one that, acts against the interest of society. Group members of the anti-
social group are usually engaged in destructive tasks and harm the civilized society. For example, any
terrorist organization will be considered as an antisocial group or a trade union, which gives a call for
national strike is antisocial.
Prosocial group: It is the reverse of antisocial group as it works for the benefit or interest of the
society. It is engaged in constructive tasks and concerned with creating the welfare of all the people
(Table 3.2).
8. GROUP DYNAMICS
Group dynamics refers to the attitudinal and behavioral characteristics of a group. It is concerned with
how groups form and function, their structure, and various other group-related process. It is relevant
in both formal and informal groups of all types. In an organizational setting, groups are a very com-
mon organizational entity, and the study of groups and group dynamics is an important area of study in
organizational behavior.
8.1. Group Development

Every group develops according to a series of some stages or phases. We have explained them as
follows:
8.1.1. Pregroup Phase

This includes selection of group members. Selection criteria include problem area, motivation, age, sex,
cultural factors, educational level, socioeconomic level, ability to communicate, intelligence, coping,
and defensive style.
8.1.2. Initial Phase

Initial phase is characterized by anxiety about being accepted by group, the setting of norms, and casting
various roles. This phase has been subdivided into three stages by Yalom (1995), which include the ori-
entation, conflict, and cohesive stage. These stages correspond to Tuckman’s (1965) first three phases
of group development: forming, storming, and norming (see Table 3.2).
TABLE 3.2 Types of Social Groups

Classification of social groups
Cooley’s F. H. Gidding’s Dwight Sanderson’s George Hasen’s

classification classification classification classification
Primary group Genetic group Involuntary group Unsocial group
Secondary group Congregate group Voluntary group Pseudosocial group
Delegate group Antisocial group
Prosocial group
Chapter 03.indd 50 5/18/2012 11:41:31 AM

TABLE 3.3 Phases of Group Development (Yalom v/s Tukman)

Yalom phase Tukman phase Task activity Interpersonal activity
Orientation Forming Joining, welcoming, Interpersonal boundaries

understanding the purpose, are identified; dependent
building relationships relationship with leaders
by new group member
Conflict Storming Airing, dissatisfaction, finding Intergroup conflict
ways through conflict, assessing
leadership, assessing member
role
Cohesive Norming To express intimate personal Group cohesiveness
opinions about task is developed, group
members adopt new roles
Working Performing To direct group energy toward Interpersonal structure
completion of task of group becomes a tool
to achieve its task; role
become flexible and
functional
Adjourning Putting closure on tasks and
relationships preparing for next
group
8.1.3. Terminal Phase

There are two type of termination: termination of the group as a whole and termination of the in-
dividual group members. A close group usually terminates as an entire group,; whereas in an open
and large group, members are terminated separately. Evaluation usually focuses on the amount of
achievement of the groups’ individual goals. If terminated successfully, members may feel a sense
of resolution about the group experience and use these experiences in many other life situations
(Table 3.3).
8.2. Group Cohesiveness

It is the degree to which the members are attracted to the group and wish to retain its membership.
Factors influencing group cohesiveness:
❑❑ Similar values and beliefs
❑❑ Same goals and tasks
❑❑ Specific needs that can be satisfied by involvement in the group
❑❑ Leader behavior
❑❑ Communication structure
Highly cohesive groups may be detrimental to organizational performance and more vulnerable to
group thinking, which may result in careless judgments, unrealistic appraisals of alternative courses of
action, and a lack of reality testing.
Chapter 03.indd 51 5/18/2012 11:41:31 AM

8.3. Group Size and Composition

❑❑ Small groups are thought to be more effective. Large groups may waste more time in any decision
making.
❑❑ Increasing the size of the group results in decreased satisfaction among the members.
❑❑ Homogeneous groups tend to function more harmoniously.
8.4. Role and Function in a Group

Group members perform various roles to ensure smooth functioning of group. Some of the important
roles are as follows:
❑❑ Leaders: To lead the group and set directions for group work.
❑❑ Encourager: To encourage the group members and have positive influence on the group to achieve
the desired goal.
❑❑ Harmonizer: To harmonize the group work.
❑❑ Conflict manager: To minimize or manage conflicts among the group members.
❑❑ Gatekeeper: To determine level of group acceptance of individual members.
❑❑ Rule maker: To set standards of group behaviors (such as time and dress).
❑❑ Problem solver: To solve problems to allow group to continue its work.
❑❑ Facilitator: To keep group focused on the topic under discussion or on the aims of the group.
❑❑ Summarizer: To state current position of group and to make summary of group work.
❑❑ Evaluator: To assess performance of group
❑❑ Initiator: To begin group discussion
❑❑ Seducer: To maintain distance and gain personal attention
❑❑ Complainer: To discourage positive work and vent anger
❑❑ Moralist: To serve as judge of right and wrong
9. TEAMWORK
Health care industry depends on teamwork to ensure better outcomes and timely accomplishments of
goal. It is a very well-established fact that no single person can deliver the entire ranges of health care
to a patient or community. Therefore, it is essential that many professionals, for example, physician,
nurse, paramedic, health educator, health visitor, public health engineer, medical social worker, phys-
iotherapist, and dietician, should work as a team to deliver the required health care to the patient. The
health care team is build up with the involvement all these professionals who are directly or indirectly
involved in improving the health of a patient or community.
Team can be build from work groups to discuss and resolve work-related issues. Teams should have
common laid down objectives, team leaders with carefully circumscribed authority, and the rules of
procedure. Teams are successful because they pool interpersonal skills, knowledge, and the expertise
needed to accomplish goals effectively and efficiently. Teamwork achieves personal recognition, raises
self-esteem, and increases motivation and commitment toward work. It is stimulated by trust, support,
acknowledgement, communication, and agreement among team members. The nurse works as a part
of health team for the management of the patient; therefore, she must be well acquainted with how to
work in a team.
Chapter 03.indd 52 5/18/2012 11:41:31 AM

9.1. How to Build Successful Work Teams?

There are 7 C’s to build a successful work team
❑❑ Clear expectations: Every member of a health team must be clear about his/her expectations to
achieve the goals of teamwork. The roles and responsibilities of each member must be clearly laid
down so that, responsibility and accountability can be imposed on him/her.
❑❑ Commitment: Every member should be committed to his/her work, roles, and responsibility.
Without commitment, success of teamwork is doubtful.
❑❑ Competence: The group members must be competent enough as per their expectation so that the
task can be carried out smoothly and efficiently. For example, a physiotherapist must be compe-
tent to provide physiotherapy.
❑❑ Control: The team leader should use effective control strategies to minimize the conflict between
the team members, make sure the availability of resources to facilitate the work, have a check on
performance of the team members in relation to the objectives, and maintain discipline between
the team members.
❑❑ Collaboration: Collaboration is essential for the success of teamwork. The team members must
collaborate with each other as per their competency level and professional skills to achieve the
desired health care goals of a patient.
❑❑ Communication: A good interpersonal communication is the essential for smooth functioning of
a team.
❑❑ Coordination: Team leader should coordinate with team members whenever required to enhance
the effectiveness of the teamwork.
10. HUMAN RELATIONS IN THE CONTEXT OF NURSING

Nursing profession is considered as humanity because nurses deal with the human beings in hospital as
well as in the community setting. Community health nurses conduct home visits and health teaching ses-
sions in the community to make people aware about diseases, their risk factors, and preventive strategies.
In every professional encounter, nurses have to deal with human beings whether they are patients or their
relatives or health care team members which may be individual or a group of people at a given time.
Therefore, it is expected from the nurse that she should be skilled in interpersonal relationship skills
because these skills are essential for initiating and maintaining interpersonal relationship. Professional
relationships are created through the nurse’s application of knowledge and understanding of human
behavior, communication of social attitude, motives, and commitment to ethical behavior. Having a
philosophy basis of caring and respect for others will help the nurse to be more successful in establish-
ing relationships of this nature.
10.1. Nurse–Client Helping Relationships

In nurse–client helping relationship, the nurse assumes the role of a professional helper and comes to
know the client as an individual who has unique health needs, human patterns, and different way of
living. The nurse’s therapeutic use of communication is the mechanism by which clients can achieve
successful outcomes for the problems by achieving optimum health.
In therapeutic interpersonal relationship, nurses often encourage clients to share personal habits, mo-
tives, attitudes, and membership of social groups through which nurses begin to understand the context
of other’s lives and learn what is meaningful for them from their perspective.
Chapter 03.indd 53 5/18/2012 11:41:31 AM

10.2. Nurse–Family Relationships

Family is considered as a primary group in sociology which has great influence on an individual through
the process of socialization. The nurse should be thorough with the family dynamics as in the home care
setting the nurse need to form helping relationships with the entire family members. The same principle
that guides one-to-one helping relationships also applies when the client is a family unit, although com-
munication within families requires additional understanding of the complexities of family dynamics,
needs, and relationships.
10.3. Nurse–Community Relationship

Community is considered as a large social group with almost the same culture, traditions, values, and
way of interaction. Nurse needs to establish effective relationship with the community members in or-
der to be an effective change agent to bring the desired changes in the health of the community people.
Understanding the importance of community-oriented, population-focused nursing practice and devel-
oping the skills to practice it are critical in attaining a leadership role in health care in order to bring
the desired change in the health status of the particular community. Without developing trustworthy
relationship with the community members, the nurse cannot bring the desired change in the health of
these people.
10.4. Nurse Health Team Relationships

In order to be a successful health team member, the nurse has to initiate and maintain social and profes-
sional relationship with the multiple health team members. Everyone has interpersonal need for accep-
tance, inclusion, identity, affection, and achievement. Communication in such relationships should be
geared toward team building, facilitating group process, collaboration, consultant, delegation, supervi-
sion, leadership, and management. A variety of communication skills are needed including presenta-
tional speaking persuasion, group problem solving, providing performance reviews, etc.
Both social and therapeutic interactions are needed between the nurse and health team members to
build morale and strengthen relationships within the work setting. Nurses need friendship support, guid-
ance, and encouragement from one another to cope with many stressors imposed by the nursing role and
also to build positive relationships with colleagues and coworker.
Chapter 03.indd 54 5/18/2012 11:41:31 AM

CHAPTER HIGHLIGHTS
❑❑ Human relation is important as it gives satisfaction, gives a sense of belongingness, boosts mo-
rale, and motivates and increases productivity.
❑❑ Human relations recognize the dignity of the individual as a human being.
❑❑ The concept of being “self” is developed throughout the life of a person.
❑❑ George Herbert Head (1964) defined self as “the sum total of people’s conscious perception of
their own identity as distinct from others. It is not a static phenomenon, but continues to develop
and change throughout our lives.”
❑❑ The term “looking-glass self” was coined by Cooley.
❑❑ Social behavior is a process of communication between the members of the society in the social
context. It essentially involves the members of the same species.
❑❑ Secondary drives are psychosocial in nature such as anxiety, fear, etc.
❑❑ Motivation is the process .of arousing the action, sustaining the activity in process, and regulating
the pattern of activity.
❑❑ According to McFarland “Motivation refers to the way in which urges, drives, desires, aspirations,
strivings, or needs direct, control, or explain the behaviour of human beings.”
❑❑ The four components of motivation are need, drive, response, and goal.
❑❑ McDougall’s theory of instinct, drive reduction theory of motivation, psychoanalytic theory of
motivation, social urge theory of motivation, behaviorist learning theories of motivation, goal-
oriented theory of cognitivism, and Maslow’s hierarchy of needs theory are some important theo-
ries of motivation.
❑❑ Thomas described attitude as the state of mind of the individual toward a value that may be love
of money, desire for fame, and appreciation for God.
❑❑ Social attitudes reflect how a group of people or society reacts toward some objects, situation,
other social group, and person.
❑❑ A group is a collection of two or more people who have a relationship with each other, are in-
terdependent, may have common norms/purposes, and work face to face on a task that require
cooperation.
❑❑ According to Cooley’s classification of social groups, there are two types of groups: primary and
secondary.
❑❑ Group dynamics refers to the attitudinal and behavioral characteristics of a group.
❑❑ According to Tuckman group development, the phases include forming, storming, norming, per-
forming, and adjourning.
❑❑ Teams are successful because they pool interpersonal skill knowledge and the expertise needed to
accomplish goals effectively and efficiently.
EVALUATE YOURSELF
1: Explain the process of group formation and maintenance (RGUHS, 2010).
Q
Q 2: Write short notes on group dynamics (NIMS, 2010; RGUHS, 2010).
Q 3: Briefly describe the motivation (NTR University, 2007; RGUHS, 2009)
Chapter 03.indd 55 5/18/2012 11:41:31 AM

4: Write a short note on social behavior (BFUHS, 2009; MGR University, 2010; NIMS, 2008).
Q
Q 5: Write a short note on teamwork (NTR University, 2010).
Q 6: Explain the meaning and definition of social group? Explain the classification of group (NTR
University, 2008).
Q 7: Explain briefly the stages of group development and what are the strategies of improving group
functioning (BFUHS, 2008).
Q 8: Explain human relations in the context of nursing (BFUHS, 2010; RUHS 2010).
1. Team building. P.S. Yoder-Wise (Ed.). “Leading and managing in nursing”, St. Louis: Mosby. pp.
276–296.
2. Building and managing teams. Sullivan E.J., Decker P.J. “Effective leadership and management in
nursing”, New Jersey: Pearson Prentice Hall. pp. 156–169.
3. Committees and other groups. Swansburg R.C., Swansburg R.J. “Introduction to management and
leadership for nurse managers”, 3rd edition. pp. 341–353.
4. Charles H. Cooley. (1902). “Human nature and the social order”, New York.
5. Ellsworth Faris. (1928). Attitudes and behavior. American Journal of Sociology, XXXIV, 271–281.
6. Lawrence K. Frank. (1928). The management of tensions. American Journal of Sociology, XXXIII,
705–736.
7. Thurstone L.L. (1928). Attitudes can be measured. American Journal of Sociology, XXXIII,
529–554.
Chapter 03.indd 56 5/18/2012 11:41:31 AM

c h a p t e r 4
Introduction to Education
1. INTRODUCTION
The history of education is believed to be as old as the history of mankind. Available literature suggests
that formal education in the form of schooling was started in Egypt between 3000 and 500 BC. The his-
tory of education is the history of mankind because human beings pass knowledge, skills, and attitude
from one generation to the other.
Education is a key factor of the prosperity and development of a nation. Well-educated citizens have
potentials for the growth and prosperity of a country. Education is considered the key to success and
growth in the life of a person.
“Being educated” is quite different from “being informed or literate.” A person who has completed
graduation or any degree from formal educational system may be considered as “informed or literate”
but not necessarily “educated.” Being an “educated” person means you are able to perceive accurately,
think clearly, and act wisely to achieve self-selected goals and aspirations. Education determines the
way of thinking and doing things. Therefore, becoming literate, getting a degree, and gaining knowl-
edge is not education.
2. DEFINITION AND MEANING OF EDUCATION

The meaning of education in common usage is “delivery of knowledge, skills and values from teachers
to students.” This meaning of education is incomplete because education is not merely the delivery of
knowledge and skills to the students; rather it is the process of becoming an educated person.
Etymologically, the word education is derived from Latin word educare (means “bring up”), which
is related to educere (means “bring forth what is within”) and ducere (means “to lead”). In Sanskrit
language, Shiksha or Vidhya words are used to refer education, which means “to discipline” and “to
know,” respectively.
2.1. Narrow Meaning of Education

The narrow meaning of education is that it is provided under the premises of schools, colleges, and univer-
sities. It doesn’t include the education that takes place outside of the four walls of educational institution.
2.2. Broader Meaning of Education

In its broad perspective, education is universal, not bounded with place and time. One can obtain educa-
tion from anywhere, anytime other than the educational institute. It is the lifelong process which starts
from cradle and ends to the grave.
Chapter 04.indd 57 5/18/2012 11:41:56 AM

Education is not meant by the syllabus that is being taught in educational institutions. It is neither the
formulas nor the practical; rather it is a way to go ahead and achieve you. To achieve yourself means the
true meaning of your being and the whole purpose of your life. It is a way that makes our life simple and
better by providing the power of self-decision.
Plants are developed by cultivation and men by education.

—Unknown
Education starts from the cradle and ends to the grave.
—Unknown
2.3. Definition of Education

Some of the great philosophers and educationist defined education as follows:
Tagore defined education as “Enabling the mind to find out the ultimate truth which emancipates us
from the bondage of dust.”
Mahatma Gandhi defined “education as mental, moral, social, physical and intellectual development
of children.” Education is the all-round development and drawing out the best in the child’s mind, body,
and spirit. It is the process that begins right from the mother’s womb.
Aristotle viewed education as “creation of sound mind in sound body.”
John Dewey defined education as “the development of all the activities in the individual enabling
him to control his environment.”
Education is what remains, after one has forgotten what one has learned in school
—Albert Einstein
Some educationists defined education in the context of its purposes. According to Ayn Rand, “The
only purpose of education is to teach a student how to live his life by developing his mind and equip-
ping him to deal with reality. The training he needs is theoretical, i.e., conceptual. He has to be taught to
think, to understand, to integrate, to prove. He has to be taught the essentials of the knowledge discov-
ered in the past and he has to be equipped to acquire further knowledge by his own effort.” Similarly,
Eric Hoffer maintained “The central task of education is to implant a will and facility for learning; it
should produce not learned but learning people. The truly human society is a learning society, where
grandparents, parents, and children are students together.”
3. AIMS OF EDUCATION
The first and foremost aim of education is to ensure the progressive development of natural abilities in
a child. Many educationist and philosophers emphasized that the main aim of education is to root moral
values in the children as it will help them in having superior ideas and better vision of living their life.
Gandhiji envisioned that education should help in the formation of good character in a person. Educa-
tion also has a social aim of making individuals responsible toward the society.
Ralph Tyler summarized the aims of education as:
1. Developing self-realization,
2. Making individuals literate,
Chapter 04.indd 58 5/18/2012 11:41:56 AM

Introduction to Education | 59
3. Encouraging social mobility,

4. Providing the skills and understanding necessary for productive employment,
5. Furnishing tools required for making effective choices regarding material and nonmaterial things
and services,
6. Furnishing the tools necessary for continued learning.
Ronald Doll mentioned the aims of education as per the various dimensions of human life:
❑❑ Intellectual dimension: Education focuses on the acquisition and comprehension of knowledge,
problem solving, skills, and various levels and methods of thinking.
❑❑ Social–personal dimension: Education is concerned with person-to-society, person-to-person,
and person-to-interactions. These aims also subsume the emotional and psychological aspects of
individuals and their adaptive aspects with regard to home, family, church, and local community.
❑❑ Productive dimension: Education centers on those aspects of education that allow the individual to
function in the home, on the job, and as a citizen and member of the larger society.
❑❑ Physical dimension: Education aims to develop and maintain strong and healthy bodies.
❑❑ Aesthetic dimension: Education aims to help an individual in dealing with values and appreciation
of the arts.
❑❑ Moral dimension: Education aims to help an individual in dealing with values and behavior that
reflect appropriate behavior.
❑❑ Spiritual dimension: Education aims to help an individual in dealing with the recognition and
belief in the divine and the view of transcendence.
The one real object of education is to leave a man in the condition of continually asking questions.
—Bishop Creighton
Individual and social aims of education are complementary to one another. The purpose of education
should be the development of the fullest possible capacities and potentialities of physical and spiritual of
a “total man.” It should make a person capable to earn his/her livelihood reasonably well to enjoy a happy
and secure life while making effective contributions to the society and national effort of making the India
strong, advanced, and prosperous. Education should be aimed to create a society where the conditions
of work and general environment offer psychic satisfactions and effective motivations to its members.
3.1. Social Change—An Aim of Education

Education should not merely equip an individual to adjust with society to its customs and conventions,
but it should enable him/her to bring desirable changes in the society. It has been, therefore, suggested
that, “Every educational institution from secondary school to university college should be developed to
become an agency of change.....”
Following is a list of expected changes caused by education
3.1.1. Modernization
Modernization of society in terms of scientific and technological advancement is possible only through
education. It is the education that enables the society to move with times and attain excellence in science
and technology.
Chapter 04.indd 59 5/18/2012 11:41:56 AM

3.1.2. Productivity
Education should bring about a social transformation and enhance greater efficiency and productivity
in all sectors: Agricultural, industrial, and service. Education enables an individual to be a productive
citizen of a productive society.
3.1.3. Focus on Local Community

The education system in all its branches and sectors should get itself involved in activities related to prob-
lems of local community life. Education should aim to study and focus the problems of local concerns
so that it will prove to be helpful for local community to understand and manage their various problems.
3.1.4. Values
Moral, cultural, and spiritual values in education have been given immense importance by the emi-
nent educationist (Mahatma Gandhi, Rabindranath Tagore, and Swami Vivekananda) as well as by the
various educations commission of India (refer educational reforms and various education commissions’
reports). Education can bring out moral, cultural, and spiritual changes in a child by cultivating qualities
of cooperation, goodwill, forgiveness, tolerance, honesty, and patience. These moral and cultural values
are necessary to be a commendable citizen of the nation.
4. PURPOSES AND FUNCTIONS OF EDUCATION

Educational theorists have made a distinction between the purpose of education and the functions of
education. A purpose is the fundamental goal of the process that is an end to be achieved, while func-
tions are other outcomes that may occur as a natural result of the process also known as by-products or
consequences of schooling. For example, transmission of knowledge is the primary purpose of educa-
tion, while the transfer of knowledge from school to the real world is something that happens naturally
as a consequence of possessing that knowledge; hence it is a function of education. Because a purpose
is an expressed goal, more effort should be put in to attain it; on the contrary, functions are assumed to
occur without directed effort. The following box represents views of some eminent educationist that
shades off light on the purposes of education (Table 4.1).
TABLE 4.1 Differences in Purpose and Function of Education

Purpose of education Functions of education
Acquisition of information about the past and Formation of healthy social and/or formal
present includes traditional disciplines such as relationships among and between students,
literature, history, science, and mathematics teachers, and others
Capacity/ability to evaluate information and to Capacity/ability to seek out alternative
predict future outcomes (decision making) solutions and evaluate them (problem solving)
Development of mental and physical skills: motor, Knowledge of moral practices and
thinking, communication, social, and aesthetic ethical standards acceptable by society/culture
Indoctrination into the culture Capacity/ability to live a fulfilling life
Capacity/ability to earn a living: career education Sense of well-being: mental and physical health
Capacity/ability to be a good citizen Capacity/ability to think creatively
Self-realization/self-reflection: awareness of one’s Self-esteem/self-efficacy
abilities and goals
Chapter 04.indd 60 5/18/2012 11:41:56 AM

No one has yet realized the wealth of sympathy, the kindness and generosity hidden in the soul
of a child. The effort of every true education should be to unlock that treasure
—Emma Goldman
The aim of education should be to teach us rather how to think, than what to think—rather to
improve our minds, so as to enable us to think for ourselves, than to load the memory with the
thoughts of other men
—Bill Beattie
5. H ISTORY AND TRENDS IN DEVELOPMENT OF NURSING AND

NURSING EDUCATION IN INDIA
❑❑ 272–236 BC: Nalanda and Takshashila, world-class universities, of that time introduced medical
education. The nurses at that time were usually men or old women.
❑❑ 250 BC: The first nursing school was established in India in 250 BC and only admitted men
Nursing did not formalize into a profession in the west until the Crimean War in the 19th century.
During that war, Florence Nightingale began cleaning hospitals and equipment. The first nursing
school was eatablished in India. Only men were eligible to get admission in nursing.
❑❑ 476–1475 AD: The monasteries became the places of education, medical care, and nursing.
❑❑ 1500–1850AD: During this time, nursing lost its social status and was not considered as an intel-
lectual work. Women of low socioeconomic status, single and widow with no hope of marriage,
were the main nursing force.
❑❑ 1854: Nightingale established nursing school at St. Thomas Hospital, London.
❑❑ 1859: The Royal Commission was appointed to look into the matters of health of Indian army
after the great Indian Mutiny of 1857.
❑❑ 1865: Miss Florence Nightingale provided suggestions on a system of nursing for hospitals in
India.
❑❑ 1867: St. Stephens hospital in Delhi started training of nursing to the Indian girls.
❑❑ 1871: The first school of nursing was started in government general hospital, Madras, with 6
months Diploma Midwives program.
❑❑ 1886: School of nursing was started in J.J. Hospital, Bombay.
❑❑ 1888: Ten fully qualified certified nurses from Florence Nightingale arrived to Bombay to lead
nursing in India.
❑❑ 1894: Regular system of training for orderliness (men for hospital work) was started.
❑❑ 1901: Men were banned to serve as nurse in Military Nursing of USA.
❑❑ 1908: Trained Nurses Association of India (TNAI) was established.
❑❑ 1910: Nursing Journal of India started publishing from the TNAI. United board of examination
was organized to conduct examination for nurses in India.
❑❑ 1911–1912: South India and North India Examining Board were created to conduct examinations
of nursing.
❑❑ 1918: Training schools were started for health visitors and dais at Delhi (India) and Karachi
(Pakistan).
Chapter 04.indd 61 5/18/2012 11:41:56 AM

❑❑ 1926: First registration council for nurses was formed at Madras presidency. Midwives Registration
Act was also formed to ensure better training of midwives.
❑❑ 1935: Bombay nursing councils were established.
❑❑ 1943: School of Nursing was established at Rajkumari Amrit Kaur (RAK) College, New Delhi.
Diploma programme in nursing administration was also started in New Delhi.
❑❑ 1946: Four-year basic Bachelor Degree programs were established at the RAK College of Nurs-
ing (1946) and CMC Vellore (1947) as per the recommendation of the Bhore committee. Nursing
education was integrated into the system of university education as per the recommendation of
University Education Commission headed by Dr. Radhakrishnan.
❑❑ 1947–1949: The Indian Nursing Council (INC) act was passed by ordinance on December 31,
1947. The INC was constituted in the year 1949.
❑❑ 1951: The syllabus was prepared for lady health visitor course by INC, and duration of the course
was reduced to 2 years from 2.5 years. The first ANM course in India was started at St. Mary’s
Hospital in the Punjab. One-year duration course in public health was started at the RAK College
of Nursing, Delhi. INC also prescribed syllabus for general nursing and midwifery course in the
year 1951, and a special provision was made for the admission of male in General Nursing and
Midwifery (GNM) course in 1954.
❑❑ 1953–1954: First organized course in psychiatric nursing started at All India Institute of Mental
Health.
❑❑ 1954: Shetty committee recommended improvement in conditions of training of nurses. Mini-
mum requirement for admission was suggested to be in accordance with regulation of the INC.
❑❑ 1959–1960: Master in nursing degree course was started at the RAK College of Nursing, Delhi.
Later on, in the year 1968–1969, College of Nursing Christian Medical College, Vellore, also
started the same programme.
❑❑ 1961: Mudaliar committee recommended minimum entrance qualification for GNM and B.Sc.
Nursing Programme. Matriculation was prescribed as minimum qualification for admission into
GNM programme; similarly, higher secondary was prescribed as minimum qualification for ad-
mission into degree course of nursing.
❑❑ 1962: Diploma in pediatric nursing was established at the J.J. Group of Hospitals, Bombay.
❑❑ 1963: School of Nursing in Trivandrum started the first 2 years postcertificate bachelor degree
program. First revision of GNM course was done in the same year. In the year 1964–1965, psy-
chiatric nursing was included in the curriculum.
❑❑ 1973: Kartar Singh Committee recommended multipurpose health worker scheme and change in
the designation of ANM and LHV.
❑❑ 1985: M.Sc. Nursing Course started in College of Nursing CMC, Ludhiana (Punjab).
❑❑ 1986: M.Phil. Nursing Programme was started in RAK College of Nursing, Delhi.
❑❑ 1988: M.Sc. Nursing Programme was started at the National Institute of Mental Health and Neu-
rosciences, Bangalore.
❑❑ 1990: Sarojini Varadappan committee recommended that Masters in nursing programme to be
increased and strengthened and Doctorate in nursing programme should be started in selected
university. Continuing education and staff development for nurses was also emphasized.
❑❑ 1991: Working group on nursing education and manpower recommended that by the year 2020,
the GNM programme should be phased out from India and curriculum of B.Sc. nursing to be
modified.
Chapter 04.indd 62 5/18/2012 11:41:56 AM

❑❑ 1992: Post Basic B.Sc. Nursing Programme was launched by The Indira Gandhi National Open
University (IGNOU), New Delhi. Ph.D. programme was started in RAK College, New Delhi.
❑❑ 1994: M.Sc. Nursing Programme was started at MAHE, Manipal.
❑❑ 1996: M.Phil. and Ph.D. nursing programmes were started at MAHE, Manipal.
❑❑ 2004: College of Nursing, All India Institute of Medical Sciences, New Delhi, started superspe-
cialty master courses in nursing (Cardiological & CTVS, Nephrological, Neurological, Critical
Care and Oncological Nursing).
❑❑ 2005: National Consortium for Ph.D. in Nursing was established under the leadership of the INC,
seven leading nursing institutions of India, World Health Organization, and the Rajiv Gandhi
University of Health Sciences, Bangalore.
6. C HANGING TRENDS, IMPACT OF SOCIOECONOMICAL,

POLITICAL, TECHNOLOGICAL CHANGES ON NURSING
EDUCATION
Scientific development, globalization, migration, and the phenomenon of the global village have
significantly changed the philosophy and way of life of the present cosmopolitan society. Social transi-
tions have brought out tremendous changes in the general as well as in the nursing education system.
The philosophy of nursing education has been affected by these social, technical, and scientific changes.
There is change toward creativity in education, transformation in teaching, learning, evaluation process,
and scientifically advanced educational technology.
The theoretical as well as practical knowledge in nursing educational system is largely borrowed
from other disciplines, for example, medicine, surgery, psychology, sociology, and many others. Scien-
tific and technological advancements in medicine (stem cell therapy and vaccination of cervical cancer)
and surgery (Gama knife surgery and robotics) along with the generation of new knowledge through
numerous researches in other disciplines pioneered changes in nursing education also. These changes
have to be incorporated in the nursing curricula in order to keep pace with the scientific and technology
advancement in the related disciplines.
Population explosion, improved living status of people, problems of nuclear family, two or one
child norm, migration from rural to urban areas, overcrowding in cities, increased pollution, emer-
gence of new diseases (bird flu, swine flu), and increased prevalence of chronic illness (diabetes mel-
litus, asthma, morbid obesity, coronary artery disease, hypertension) are some of the social changes of
twenty-first century. The educational system of the medicine, surgery, as well as in the nursing sciences
has responded to these social changes by developing specialities and super specialities courses. The
increased elderly population has placed demand for more geriatric nurses in the future. In order to cater
to this demand, there is a need to develop a cadre of geriatric nurses for future by opening more courses
in geriatric nursing in India.
Transformation in the discipline of medicine and surgery in turn has affected the nursing profes-
sion, resulting in emergence of new speciality and super speciality course in nursing education, for
example, anesthetic nursing, cardiovascular nursing, oncology nursing, nephrological nursing, critical
care nursing, and forensic nursing. The All India Institute of Medical Sciences, New Delhi, a premier
health institution of India, has taken leadership steps in the development of these super speciality areas
in Indian nursing education system. Advancement in medical technology has also emphasized the need
of continuing education programmes in nursing.
Chapter 04.indd 63 5/18/2012 11:41:56 AM

As a result of population explosion, there is a dire need of growing numbers of nurses across the
globe. In India, to cater to the increase demand of nurses, INC has relaxed norms to establish school or
colleges of nursing that paved the way to increase the number of nursing institutions in India.
Transcultural nursing is the other area that has emerged out as a result of migration of nurses from
developing to developed countries as well as due to modern trend of health tourism. Patients from de-
veloped countries where health care costs are rising sharply are moving toward developing countries
to get cheaper and quality treatment. Increasing trend of health tourism paved the way for improved
physical infrastructure of corporate and other hospitals in India. There is great demand of qualified and
competent nurses to fulfill the need of growing health tourism in India. Cultural diffusion and family
disintegration has given rise to the problems of drug addiction, alcoholism, premarital sex, and emer-
gence of HIV/AIDS. There is a shift of emphasis on the concerned areas of present interest in nursing
education.
The dire need of highly competent nurses by the health care industry has influenced the curriculum
models in nursing educational system. There is a shift from traditional nursing curriculum to objec-
tive- and competency-based curriculum. The INC has taken initiative in this direction by incorporating
competency statements in the guidelines of various nursing programmes in India. Similarly, to cater to
the need of safe delivery among rural women, the concept of nurse midwife practitioner has emerged
out. INC has developed guidelines and protocols of drugs that a midwife practitioner can administer.
Increased cost of living has raised importance of such education programmes which can be imple-
mented on the job. In India, post basic diploma programmes in various speciality areas (post basic
diploma in cardiothoracic nursing, oncology nursing, and OT nursing) are fighting with the problem of
low admission rate of the students. Remedy to solve this issue may be provision of on-the-job admis-
sions in these programmes or provision of stipend equal to the salary to these students. To cater to the
need of increasing numbers of nursing graduates, distance-education programmes should be expanded
liberally but without compromising the quality of education.
Advancement in communication technology and computer has incorporated some superior teaching
strategies in the nursing curriculum such as programmed instruction, computer-assisted learning, and
online and e-learning. Computer as an aid to nursing education is useless without software design to
support learning; therefore, faculty of nursing sciences need to put extra efforts to develop content ma-
terials as well as software so that technological advancement can be exploited to provide better nursing
education.
Mobile phone has become an integral part of everyday’s life which has also affected the education.
Nowadays, a nurse can know the side effects and doses of newer drugs and review the latest research
articles anytime anywhere by just clicking certain keys on her mobile or tabloid or 3G tab.
The large number of graduates passing out every year poses a challenge for regulatory bodies of
nursing to maintain the quality of nursing education in India so that competent first-line nurses can be
prepared to serve the humanity in this era of quality assurance and patient rights bill. There is a need
to change the educational model of nursing, which is largely based on the traditional medical model.
The concept of dual position needs to be applied in nursing education so that theory practice gap can
be plugged. New methods of assessment such as objective structured clinical evaluation (OSCE) and
objective structured practical examination (OSPE) require modifications in the curriculum of nursing
education.
Issues and trends facing nursing education pose challenges for students as well as for nurse educa-
tors. Curriculum changes in various nursing education programmes must reflect these social changes,
trends, and technological advancement.
Chapter 04.indd 64 5/18/2012 11:41:56 AM

7. TYPES OF EDUCATION
Education can be divided into three types:
1. Formal education
2. Informal education
3. Nonformal education
7.1. Formal Education

Formal education is linked with schools, colleges, university, and training institutions. It is a system of
education that starts from prenursery school and ends in university. It also includes a variety of special-
ized courses and institutions for full-time technical and professional training.
Due to rapid expansion of population and the propagation of compulsory education, UNESCO has
estimated that in the next 30 years, more people will receive formal education than in all of human his-
tory so far.
7.2. Informal Education

Informal education is the lifelong process in which people learn from everyday experience. Informal
education covers what we learn through interactions with friends, family, and work colleagues and also
through our own initiative. It is truly a lifelong process whereby every individual acquires attitudes,
values, skills, and knowledge from life experiences, family and neighbors, work and play, library, and
the mass media.
7.3. Nonformal Education

Nonformal education is an organized educational activity that occurs outside the formal systems of
education. It may include any organized educational activity outside the established formal system.
Nonformal education is learning acquired independently through nonacademic means. It can either
mean that you are self-taught through your own reading and research or through experience. Some-
times, nonformal education is also referred to as “the school of life” (Table 4.2)
8. DISTANCE EDUCATION
Distance education aims to deliver teaching to students who are not physically present in a traditional
educational setting such as a classroom. It has been described as “a process to create and provide access
to learning when the source of information and the learners are separated by time and distance, or both.”
Distance-education courses that require a physical onsite presence for any reason (including taking
examinations) have been referred to as hybrid or blended courses of study.
Distance education uses a variety of information technologies to connect students and faculty who are
not able to meet because of barriers of time or space. Instruction are specially designed for distance educa-
tion that transcends the classroom, supporting the learner who must assume additional responsibility for
learning and promoting meaningful interaction that overcomes the separation of the teacher and student.
8.1. Types of Distance Education

There are two types of distance education: synchronous and asynchronous distance education.
Chapter 04.indd 65 5/18/2012 11:41:56 AM

TABLE 4.2 Differences in Formal, Nonformal, and Informal Education

Formal education Nonformal education Informal education
Purposes Credential based, included what Noncredential based Consists of the norms
students are taught from the and values acquired
syllabus from the school
Timing Long cycle/full time Short cycle/recurrent/part time environment, such as
doing what you are
Content Standardized/input centered Individualized/output centered
told and acceptance
Academic entry requirements Practical
of a hierarchy.
determine clientele
Sociologists often
Delivery Institution based, isolated from Environment based, flexible, call informal
system environment learner centered, and resource education
Rigidly structured, teacher saving the “hidden
centered, and resource intensive curriculum”
Control External/hierarchical Self-governing/democratic
Adapted by Fordham, 1993 from Simkins, 1977:12–15.
Synchronous Distance Education

Synchronous distance education takes place when the teacher and student, although separated, are par-
ticipating in the educational experience at the same time aided by some connecting technology (e.g.,
live, interactive television or online computer “chats”) resembling traditional classroom teaching meth-
od despite the participants being located remotely.
Asynchronous Distance Education
In asynchronous mode of distance education, the student and faculty are not participating at the same
time in teaching learning. The student accesses course materials as per his/her convenience; therefore,
it is considered as a more flexible approach of distance education. Mail correspondence, which is the
oldest form of distance education, is an asynchronous delivery technology of distance education.
The two methods can be combined in the delivery of one course. For example, some courses (Post
Basic B.Sc. Nursing) offered by IGNOU, New Delhi, use periodic sessions of residential or day teach-
ing to supplement the remote teaching (mail correspondence).
8.2. Effectiveness of Distance Education

Distance education has proved to be an effective delivery system for nursing education. Research studies
comparing distance education with traditional classroom experiences concluded that academic achieve-
ment, socialization, and mentoring opportunities are comparable or improved by using distance education.
In addition, students report satisfaction with learning at a distance, probably because of the convenience
of being able to take courses at their chosen time and place. Distance-learning courses are getting popular
in India, and lots of students want to earn their degree while working with this mode of education.
Here is a list of universities offering Post Basic B.Sc. Nursing Programme through distance learning:
1. IGNOU-B.Sc. Nursing (Post Basic): Eligibility: 10+2 with 3 years Diploma in GNM with mini-
mum of 2 years experience in the profession. OR 10th class (Matriculation) or its equivalent with
3 years Diploma in GNM with minimum of 5 years experience in the profession.
2. Vinayaka Mission University Salem, Tamil Nadu.
Chapter 04.indd 66 5/18/2012 11:41:56 AM

9. PHILOSOPHY OF EDUCATION
9.1. Meaning of Philosophy
Philosophy is defined as love of wisdom, the pursuit for knowledge. It is often concerned with such
things as power, provocation, personality offering brainstorm to people caught up in the storm of social
crisis and ideological arguments. It is a search for meaning and truth and provides a framework for life
and our action. It is also useful in solving educational problems.
Educationist philosophers are concerned with questions of curriculum, teacher, schools, students,
and society. Philosophy of education is a “the philosophical study of education and its problems.” It
seeks to address questions regarding the aims of education, education policy, and curriculum as well as
the process of learning. Therefore, it can be said that philosophy of education is the philosophical study
of the purpose, process, nature, and ideals of education. Educational aims and objectives are derived
from the underlying philosophy of the educational system (Figure 4.1). A philosophical enquiry focuses
on three major areas which are as follows:
Metaphysics is concerned with the “nature of reality.”
❑❑ Epistemology is concerned with the “nature of knowledge” or “what can be known.” It deals with
theories of the nature of knowledge. Epistemological questions include: How do people learn?
What are the different types of knowledge?
❑❑ Axiology is concerned with the “nature of values (ethics and aesthetics: right or wrong and the
beautiful).”
Axiology
Major areas
of philosophy
Metaphysics Epistemology
Figure 4.1 Major Areas of Philosophical Concern
Chapter 04.indd 67 5/18/2012 11:41:57 AM

“In modern times there are opposing views about the practice of education. There is no general agree-
ment about what the young should learn either in relation to virtue or in relation to the best life; nor is
it clear whether their education ought to be directed more towards the intellect than towards the char-
acter of the soul.... And it is not certain whether training should be directed at things useful in life, or at
those conducive to virtue, or at non-essentials.... And there is no agreement as to what in fact does tend
towards virtue.”—Aristotle
Aristotle wrote this passage more than 2,300 years ago, and today educators are still debating the
issues he raised. Different approaches to resolving these and other fundamental issues have given rise
to different schools of thought in the philosophy of education.
Education should be for the highest good. Most important thing to teach is values of the highest sort
—Plato
Important philosophical schools of thoughts that have influenced the educational system are as follows:
9.2. Idealism (Idea-ism)

An idealist believes that ideas are the only true reality. The material world is characterized by change,
instability, and uncertainty, but some ideas are enduring. We should be concerned primarily with the
search for truth. Since truth is perfect and eternal, it cannot be found in the world of matter that is both
imperfect and constantly changing.
Leaders of idealism: Socrates, Plato, St. Augustine, Descartes, Berkeley, and Kant
Idealism believes in the study of the classics for universal truths such as mathematics (2+2=4 is an ab-
solute truth) and dialectic (critical discussion) to look at both sides of the coin. According to idealism,
true education is concerned with ideas rather than matter. The idealists want to give students a broad
understanding of the world in which they live. The aims of education according to this school of thought
include developing the mind, search for true ideas, character development, and self-realization.
Views of Plato, the father of idealism, toward education are as follows:
❑❑ Students with little ability for abstraction should go into the military, business, and industry.
❑❑ Those who demonstrate proficiency in the dialectic would continue their education and become
philosophers in positions of power to lead the state toward the highest good.
❑❑ He believed that both boys and girls should be educated and girls should be equals.
Descartes, a great proponent of idealism, concluded that “I think, therefore I am.” Thinking and ideas
are the ultimate truth.
Immanuel Kant viewed that education should teach students how to think according to principles,
moral laws, moral ideals, and moral imperatives. Enlightenment is the goal of education.
Example: The idealist and the car: To an idealist, the concept of “car” is important. You could destroy
all the cars in the world, but they would still exist in the mind. The idea of a car is the ultimate truth.
Chapter 04.indd 68 5/18/2012 11:41:57 AM

9.3. Realism
On contrary to idealism, the philosophy of realism maintains that material and physical world exists
independent of ideas and thoughts. Whether we think about a mountain or not, it does exist. It will exist
even if we don’t think about it or have never had an idea of what a mountain is like. Therefore, realist
educationists would focus the students to learn through their senses of smell, feel, and taste since they
believe in the existence of the natural world. Realistic educationist strongly believes that the best way
of learning is through experiencing the physical world with the senses.
Leaders of realism: Aristotle (384–322 BC), Thomas Aquinas (1225–1274), Francis Bacon
(1561–1626), and John Locke (1632–1704)
Nature plays an important role in learning, so an educationist should prefer to teach students through
observation of natural order. The teachers with realistic bend of mind would want students to develop-
ment judgment and ethics by experiencing and observing the world.
Realism maintains that:
❑❑ At birth, the mind is a blank sheet of paper. All ideas are derived from experience by way of sensa-
tion and reflection—John Locke.
❑❑ Reality, knowledge, and value exist independent of the human mind. Trees, sticks, and stones ex-
ist whether or not there is a human mind to perceive them.
❑❑ Universal properties of objects remain constant and never change, whereas particular components
do change.
❑❑ Need to study nature systematically.
❑❑ Deductive reasoning—truth is derived from generalizations.
❑❑ Ideas may be important, but a proper study of matter could lead us to better and more distinct
ideas.
❑❑ Truth was passed from God to humans by divine revelation, but God also has endowed humans
with the reasoning ability to seek out truth.
❑❑ Science must be concerned with inquiry, pure and simple, with no preconceived notions.
9.3.1. Realism and Education

❑❑ Realism promotes the study of science and the scientific method.
❑❑ There are essential ideas and facts to be learned; therefore lecture and other formal methods of
teaching are useful.
❑❑ Approve of competencies, performance-based teaching, and accountability.
❑❑ Teacher should present material in a systematic, organized way and teach that there are clearly
defined criteria for making judgments in art, economics, politics, etc.
Example: The realist and the car: To a realist, the actuality of “car” is important. A realist would
measure the car, weight it, examine the physical characteristics, etc. The fact that the car exists is
the ultimate truth in realism school of thought.
Chapter 04.indd 69 5/18/2012 11:41:57 AM

9.4. Pragmatism
The root of the word pragmatism lies in a Greek word which means “Work.” It is primarily a twentieth-
century philosophy developed by Americans. Charles Sanders Peirce is widely acknowledged as the fa-
ther of pragmatism who wrote an article on “How to make our ideas clear” in a popular Science monthly
that is regarded as the basis for pragmatism. Pragmatism emerged out from the writings of John Dewey
who believed that experimentation was the best approach for educating young minds. George R. Knight
in his book on education philosophies mentioned that pragmatism focuses on real-life experiences as the
main source of knowledge and education.
For example, field trips and educational excursions/exhibitions, which provide real-life experiences,
are more effective in teaching students about the world instead of lecture cum discussion or audiovisual
aids. In order to provide learning about dairy products, it is better to take a student to a store and let him/
her experience the whole thing himself/herself instead of showing him/her a movie (audiovisual aid)
on the subject. Pragmatic education philosophy doesn’t assign a traditional role to the teachers. Rather,
they are seen as guides and not exactly more knowledgeable beings.
Pragmatism maintains that:
❑❑ The truth of an idea is its “workability.” Truth is not absolute and immutable; rather it is made in
actual, real-life—William James
❑❑ Ideas should be applied to solving problems, including social problems.
❑❑ Reality is not found in being, but in becoming. Reality is open ended, in process, with no fixed
end.
Leaders in pragmatism: Auguste Comte (1798–1857), Charles Darwin (1809–1882), William

James (1842–1910), and John Dewey (1859–1952)
John Dewey, an eminent educationist and philosopher supporting pragmatism, maintains that:
❑❑ Education should conform to real-life experiences.
❑❑ Aims of education are for maximum societal participation and moral reflection.
❑❑ There is tension between school’s necessity of balancing the needs of society and of individuals.
❑❑ Educated person is always within a social context. Education and morality are linked with each
other.
❑❑ Teacher’s role is to select the appropriate experiences for the child. All educational experiences in
schooling are interrelated….forerunner of interdisciplinary learning.
❑❑ Education is the fundamental method of social progress and reforms.
9.4.1. Pragmatism and Education

❑❑ Education should be preparation for life. It should be action oriented.
❑❑ Solving problems is important; therefore use real-life situations in teaching–learning process.
❑❑ Teaching methods should be varied and flexible. Project approach to teaching is desirable.
❑❑ Needs and interests of students should be considered; hence curriculum should be diverse and a
broad education is more desirable.
Chapter 04.indd 70 5/18/2012 11:41:57 AM

Example: The pragmatist and the car: To a pragmatist, the use or workability of the “car” is
important. The pragmatist is concerned with the question “What is the purpose of the car and does
it fulfill that purpose?” The “workability” of a car is the ultimate truth for him.
9.5. Naturalism
Naturalism is the doctrine that separates the nature from God, considers matter superior to spirit, and
sets up unchangeable laws as supreme. According to this philosophical school of thought, nature is
supreme, all answers should be sought in nature, and it alone can solve all the philosophical problems.
Naturalism came to surface at a time when education was confined within the rigid rules of discipline
under the influence of idealism. Naturalism aims at making education free from the bondage of rigid
discipline under which children were tortured. Naturalistic viewed the education as a natural biological
process of children, which should take place within nature. They firmly affirmed that education should
not be meant by formal training.
Naturalism is a word applied to those principles of training which do not depend on schools and
books but upon the laws of natural life of the educant
—Adams
9.5.1. Naturalism & Curriculum

Naturalism does not favor in imposing any boundary on the children. So advocates of this theory have
not framed any curriculum of education. They believed that each and every child has the capacity to
frame his/her own curriculum as per his/her requirements. A child will gather experience from nature
according to his/her own demand. He should not be forced to practice any fixed curriculum. Later on,
under the influence of scientific development, naturalism believed that to give natural pleasure to man,
science should be utilized in life. Therefore, their concept of curriculum also changed under the influence
of scientific development. According to neonaturalists, curriculum should be broad and the practice of
science should be given priority. Considering the views and needs of the children, the experiences of the
curriculum should be selected. Neonaturalists have advised to include the following in the curriculum:
❑❑ Science dealing with nature: Physics, Chemistry, and Botany to acquaint the child with nature.
❑❑ Mathematics and language. These will be helpful to acquire the knowledge of the subjects of
science.
❑❑ History and Social Science: In order to acquire modern knowledge, one should focus on the pro-
cess of evolution. It will also help to realize the importance of those in their present life.
❑❑ Agriculture and carpentry will offer opportunity to the children to act them in freedom and will
increase their power of observation.
❑❑ Naturalists felt the importance of Physical Education and Health Training for self-protection.
❑❑ Drawing naturalists have considered drawing as the main technique of self-expression. They have
included drawing as compulsory in the curriculum. They also maintained that ethical training
should not be imposed on children. They will build their own ethical sense in natural order by
receiving rewards and punishments.
Chapter 04.indd 71 5/18/2012 11:41:57 AM

9.5.2. Role of Teacher

Naturalist philosophers envisaged that a child can learn by self-activity, through the senses, learning by
doing, and play education; therefore, the method that makes a child inactive cannot be considered as a
teaching. The role of the teacher is not to deliver knowledge; rather they should focus to create a proper
environment in which a child will get opportunity of working in freedom. The role of the teacher should
be that of an observer and facilitator. He/She will observe their process of works and protects them,
thereby facilitator their learning processes. A well-known naturalist philosopher remarked that “Teacher
is a seller of the stage, a supplier of materials and opportunities, a provider of an ideal environment and
creator of conditions, conducive to natural development of pupils.”
9.6. Reconstructionism
The doctrine of reconstructionism envisaged that society is in need of constant reconstruction, and such
social change involves both a reconstruction of education and the use of education in reconstructing
society. Reconstructionists emphasized that education should enable a child to link thought with action,
theory with practice, and intellect with activism. The goal of education should be to emphasize the need
for change.
Reconstructionists: George S. Counts, Theodore Brameld, Paole Freire, Karl Marx, and Ivan
Illich
Example: The reconstructionist and the car: To a reconstructionist, the redesign of the “car” to
better serve the needs of society is important. How can the car be improved to better serve the
modern society of the future?
9.7. Existentialism
Existentialism sprang from a strong rejection of the traditional, essentialist approach to education.
Existentialism rejects the existence of any source of objective, authoritative truth about metaphysics,
epistemology, and ethics. Instead, they believed that individuals are responsible for determining for
themselves what is “true” or “false,” “beautiful” or “ugly.” For the existentialist, there exists no univer-
sal form of human nature; each of us has the free will to develop as we see suitable. They believe that
people come first, then ideas. People create ideas so emphasis of education should be on self-discovery.
Existentialists: Soren Kierkegaard, Martin Heidigger, Martin Buber, and Jean-Paul Sartre
9.7.1. Existentialism as an Educational Philosophy

❑❑ A good education emphasizes individuality. Education should be varied as per the individual
preferences.
❑❑ Students shouldn’t have to attend classes, take examinations, and receive grades, and there should
not be set curriculum.
Chapter 04.indd 72 5/18/2012 11:41:57 AM

❑❑ The teacher’s role is to help students define their own essence by exposing them to various paths
they may take in life and creating an environment in which they may freely choose their own
preferred way.
❑❑ Learning is self-paced, self-directed, and includes a great deal of individual contact with the
teacher, who relates to each student openly and honestly.
Example: The existentialist and the car: To an existentialist, the individual’s use of “car” is im-
portant. Whatever the individual wants to do with the car is much more important. The experience
of the individual with the car is the ultimate truth.
9.8. Educational Reforms and Various Education Commission Reports

After independence, the government of India appointed University Education Commission to look into
the existing system of the education in the nation. Thereafter, in order to keep pace with the social
changes as well as scientific and technological advancements, the government of India appointed some
other education commissions to reform the existing educational system in order to satisfy social changes
and scientific advancement.
9.8.1. University Education Commission, 1948–1949

University education commission was appointed under the chairmanship of Dr. Radha Krishnan by the
government of India within a year after independence. The commission was given the responsibility
to suggest structural and qualitative changes in higher education, which were necessary after freedom
as the English system of education was not appropriate in free democratic India. Given below are the
highlights of the report submitted by the commission to the government of India.
❑❑ The commission suggested that the purpose of school education should not be merely preparing
the students for university work; rather, it should also focus on vocational work so that a student
can earn his/her livelihood if he/she is not going to university for higher education.
❑❑ The school education should also focus on physical training and group activities other than the
intellectual knowledge.
❑❑ Secondary Schools should insist on the equal dignity and importance of the different courses they
offer. Every pupil should have knowledge of the physical world in which he lives (Geography).
Everyone should know something of the society in which he/she lives, the great forces that mould
contemporary civilization (Social Sciences). The study of the language and the literature of our
mother tongue should occupy the first place in general education.
❑❑ The commission suggested in relation to reform of secondary education that a student should not
be admitted to a university until he/she has passed the intermediate examination.
❑❑ In relation to professional education, the commission suggested that the foundation of profes-
sional education should not only include technical skill, but also a sense of social responsibility,
an appreciation of social and human values and relationships, and disciplined power to see reali-
ties without prejudice. All technical education should transmit technical understanding, skill, and
method, not as an isolated discipline, but in its total human and social setting.
Chapter 04.indd 73 5/18/2012 11:41:57 AM

❑❑ Women education was an important area that was emphasized by the commission. It recom-
mended that women education should familiarize a woman with problems of home management
and skills in meeting them.
❑❑ The commission also focused on nursing education and suggested two types of nursing courses:
one is diploma grade course of 2 years duration after 10 years of schooling to produce “practical
nurse”; other is B.Sc. degree course after high school to produce “professional nurses.” Studies
for degree courses should include general education, together with course in physical and biologi-
cal science as preparation for the specialized courses of nursing education. The nursing courses
should be combined with actual practice at caring for the sick. The duration of the course should
be the same as that required for the B.Sc. degree.
9.8.2. The Secondary Education Commission (Mudaliar Commission), 1952

Secondary Education Commission was appointed in 1952 under the Chairmanship of
Dr. A. Lakshmanaswamy Mudaliar to suggest reforms necessary in secondary education.
Recommendations of the Secondary Education Commission

❑❑ Commission suggested a new organization pattern of secondary education that should commence
after 4 or 5 years period of primary education.
❑❑ The intermediate stage should be replaced by the higher secondary stage, which should be of 4
years duration, 1 year of the present intermediate being included in it.
❑❑ Admission to professional colleges should be open to those who have completed the higher sec-
ondary course, or have taken the preuniversity course.
❑❑ The mother tongue or the regional language should generally be the medium of instruction
throughout the secondary school stage.
❑❑ At the high and higher secondary stage, at least two languages should be studied, one of them
being the mother tongue or the regional language.
❑❑ Educational guidance should receive much greater attention on the part of educational authorities;
the services of trained guidance officers and career masters should be made available gradually
and in increasing measure to all educational institutions.
❑❑ The number of external examinations and subjectivity in the essay-type tests should be minimized
by introducing objective tests and also by changing the type of questions.
9.8.3. National Education Commission (Kothari Commission), 1964–66

The commission identified that the most important and urgent reform needed in education is to relate
it to the life, needs, and aspirations of the people and thereby make it a powerful instrument of social,
economic, and cultural transformation necessary for realization of the national goal. Some important
recommendations given by the National Education Commission are as follows:
❑❑ Science education should be an integral part of school education and ultimately become a part of
all courses at the university stage.
❑❑ Vocationalization of secondary education as well as agricultural and technical education should
be emphasized.
❑❑ Common school system of public education should be adopted as the national goal.
Chapter 04.indd 74 5/18/2012 11:41:57 AM

❑❑ The development of a common school system of public education in which no fees would be
charged, where access to good schools will be open to all children on the basis of merit, and where
the standard maintained would be high enough.
❑❑ Adoption of regional language as the medium of instructions.
❑❑ Energetic action is required for production of books and literature, particularly scientific and
technical, in regional languages.
❑❑ Provision of free and compulsory education of good quality for all children up to the age of 14 years.
❑❑ The education system should emphasize the development of fundamental, social, moral, and spiri-
tual values.
❑❑ Upgrade the remuneration of teachers substantially, particularly at the school stage.
❑❑ The quality of the programme of teacher education should be improved.
❑❑ The most important reform for higher education is the development of some major universities
where first class postgraduate work and research would be possible and whose standards would
be comparable to the best institutions of their type in any part of the globe.
❑❑ At the earlier stage of the undergraduate course, the bulk of the instruction may be given through
the regional language while at the postgraduate stage it may be in English.
9.8.4. National Policy on Education, 1968

National policy on education surfaced out from the discussion in the parliament on recommendations of
the Kothari Commission. It laid stress on the need for a radical reconstruction of the education system,
to improve its quality at all stages, and gave much greater attention to science and technology, the culti-
vation of moral values, and a closer relation between education and the life of the people. The highlights
of the policy are as follows:
❑❑ Uniform structure of education system throughout the country based on 10+2+3 system of
education.
❑❑ Gradual increase of investment in education up to 6% of national income to meet the need of extra
resources required for restructuring of education.
❑❑ Salary and service conditions of the teachers should be in accordance with their qualifications and
work responsibilities. In-service training of the teachers should be ensured.
❑❑ In order to rectify regional inequalities in educational facilities, good educational infrastructure
has to be developed in rural and backward areas.
❑❑ Compulsory women education to ensure social justice.
❑❑ Provisions to ensure education to backward class, schedule caste, schedule tribe, and handicapped
children.
❑❑ Need to improve curriculum to make it useful as well as to improve textbooks and teaching strategies.
❑❑ Special emphasis to science, technical, and vocational education in school education.
❑❑ Increase in scholarship schemes to motivate the students of weaker section of society for education
as provision of short-term courses and distance-education courses.
9.8.5. National Education Policy, 1986

The highlights of national education policy (1986) are as follows:
❑❑ Development of necessary skills and abilities in children as per the requirement of twenty-first
century.
Chapter 04.indd 75 5/18/2012 11:41:57 AM

❑❑ Improvement in facilities for the expansion and development of primary education.

❑❑ Admission to higher education and technical education should be based on qualification.
❑❑ Due emphasis on open and distance education, informal education, national literacy programme
to increase the opportunities of education and development of society.
❑❑ Development of minimum admission criteria at every level of education so that equality and qual-
ity of education can be maintained throughout the country.
❑❑ Appropriate formal and nonformal programmes of technical education should be devised for the
benefit of women, the economically and socially weaker sections, and the physically handicapped.
❑❑ Special emphasis on the removal of disparities and to equalize educational opportunity by paying
attention to the specific needs of those who have been denied equality so far.
❑❑ Universal enrolment and universal retention of children up to 14 years of age.
❑❑ A large and systematic programme of nonformal education should be launched for school drop-
outs, for children from habitations without schools, and for working children and girls who cannot
attend whole-day schools.
❑❑ A beginning should be made in delinking degrees from jobs in selected areas. Delinking will be
applied in services for which a university degree need not be a necessary qualification.
❑❑ The new pattern of the rural university will be consolidated and developed on the lines of Mahatma
Gandhi’s revolutionary ideas on education.
9.8.6. Yashpal Committee, 1992

The important recommendations of the Yashpal Committee are as follows:
❑❑ Setting up education committees at village, block, and district level to undertake planning and
supervision of schools under their jurisdiction.
❑❑ Sufficient contingency amount (not <10 per cent of the total salary bill of the school) to be placed
at the disposal of the heads of schools for purchase, repair, and replacement of pedagogical
equipment.
❑❑ Jurisdiction of CBSE be restricted to Kendriya and Navodaya Vidyalayas and all other schools be
affiliated to the respective State Boards.
❑❑ There is no jurisdiction for torturing the young children by compelling them to carry very heavy
bags of books every day to schools. Textbooks should be treated as school property, and thus there
should be no need for children to purchase the books individually and carry them daily to homes.
❑❑ The existing norm for teacher–pupil ratio (i.e., 1:40) should be enforced, and all attempts should
be made to reduce this to 1:30, at least in the primary classes, as a basis for future educational
planning.
❑❑ Greater use of the electronic media for the creation of a child-centered social ethos in the country.
A regular television programme “Shiksha Darshan” be launched, along the lines of the “Krishi
Darshan” programme.
❑❑ B.Ed. programme has to be a rigorous, thorough, and intensive. Therefore, B.Ed. degree courses
by correspondence to be derecognized.
Chapter 04.indd 76 5/18/2012 11:41:57 AM

9.8.7. Revised National Education Policy, 1992

The implementation programme of national policy of education (1986) was modified as per the sugges-
tion of “Janardan Reddy Committee”, and a modified plan of action was prepared which highlighted
the following points:
❑❑ Provision of minimum three teachers and three classrooms in each school.
❑❑ Establishment of common schools instead of laborhood and special schools.
❑❑ Continuation of the schemes of “operation black board and school complex.”
❑❑ Initiation of vocational education in secondary schools along with higher secondary schools.
❑❑ District literacy mission to be started for adult education.
9.8.8. Right of Children to Free and Compulsory Education Act, 2009

This act made provision of free and compulsory education for the children of the age of 6 to 14 years.
It requires all private schools to reserve 25% of seats to children from poor families. It also prohibits
all unrecognized schools from practice and makes provisions for no donation or capitation fees and no
interview of the child or parent for admission into the school.
Chapter 04.indd 77 5/18/2012 11:41:57 AM

CHAPTER HIGHLIGHTS
❑❑ Education is not meant by the syllabus being taught in the schools. It is neither the formulas nor
the practical. Rather, education is a way to go ahead and achieve you.
❑❑ Aristotle viewed education as “creation of sound mind in sound body.”
❑❑ According to John Dewey, education is the development of all the activities in the individual,
enabling him/her to control his/her environment.
❑❑ Ralph Tyler summarized the aims of education as: (a) developing self-realization, (b) making
individuals literate, (c) encouraging social mobility, (d) providing the skills and understanding
necessary for productive employment, (e) furnishing tools requisite for making effective choices
regarding material and nonmaterial things and services, and (f) furnishing the tools necessary for
continued learning.
❑❑ A purpose is the fundamental goal of the process that is an end to be achieved. Functions are other
outcomes that may occur as a natural result of the process also known as by-products or conse-
quences of schooling.
❑❑ Formal education, informal education, and nonformal education are the three types of education.
❑❑ Formal education is concerned with schools, colleges, university, and training institutions.
❑❑ Informal education is the lifelong process in which people learn from everyday experience.
❑❑ Nonformal education refers to organized educational activity outside the formal systems of
education.
❑❑ Distance education has been described as “a process to create and provide access to learning when
the source of information and the learners are separated by time and distance, or both.”
❑❑ Philosophy is defined as love of wisdom. It is often concerned with such things as power, provo-
cation, and personality.
❑❑ Philosophy of education is “the philosophical study of education and its problems.”
❑❑ Idealist believes that ideas are the only true reality.
❑❑ Realism philosophy maintains that material and physical world exists independent of ideas and
thoughts.
❑❑ Realism maintains that the truth of an idea is its “workability.” Truth is not absolute and immu-
table; rather it is made in actual, real life.
❑❑ Naturalism is the doctrine that separates nature from God. According to this philosophical school
of thought, nature is supreme, all answers should be sought in nature, and it alone can solve all
the philosophical problems.
❑❑ Existentialism rejects the existence of any source of objective, authoritative truth about metaphys-
ics, epistemology, and ethics.
❑❑ University Education Commission, 1948–1949, recommended two types of nursing courses: one
is diploma grade course of 2 years duration after 10 years of schooling to produce “practical
nurse,” other is B.Sc. degree course after high school to produce “professional nurses.”
❑❑ The Secondary Education Commission (Mudaliar Commission), 1952, National Education Com-
mission (Kothari Commission), 1964–1966, and Yashpal Committee, 1992, are important com-
missions in the history of education in India which reformed the Indian system of education.
❑❑ Right of Children to Free and Compulsory Education Act, 2009, made provision of free and
compulsory education for the children of the age of 6 to 14 years.
Chapter 04.indd 78 5/18/2012 11:41:57 AM

EVALUATE YOURSELF
1: Explain briefly the philosophy and aims of nursing education (RGUHS, 2009).
Q
Q 2: Explain the current trends in nursing education (MGU, 2008).
Q 3: Explain the difference between pragmatism and naturalism (MGU, 2007).
Q 4: Explain the difference between pragmatism and idealism (MGU, 2008).
Q 5: Explain the relationship between philosophy and education (RGUHS, 2006).
Q 6: Write a short note on idealism (MGU, 2009).
Q 7: Explain the trends and issues in nursing education (MGU, 2009).
1. Wilkinson A. (1965). “History of nursing in India and Pakistan”, New Delhi: TNAI.
2. TNAI (2000). “History and trends in nursing in India”, New Delhi.
3. Hurndr R., Letiman B. (183). “Nursing education in India”, New Delhi: TNAI (1995).
4. “Indian Nursing Year Book”, 1993–1995, New Delhi: TNAI.
5. TNAI (2002). “Indian Nursing Year Book”, 2000, New Delhi: TNAI.
6. Callaway R. (1979). “Teachers’ beliefs concerning values and the functions and purposes of
schooling, Eric Document Reproduction Service No. ED 177 110.
7. Aggarwal J.C. “Theory and principles of education; philosophical and sociological bases of
education.”
8. Lethbridge D.J. (1998) Independent study: A strategy for providing baccalaureate education for
RNs in a rural setting. Journal of Nursing Education , 27, 183–185.
9. Rufo K.L. Effectiveness of self-instructional packages in staff development activities. Journal of
Continuing Education in Nursing, 1985, 16, 80–83.
10. Billings D., Marriner A., Smith L. (1986). Correspondence courses: An alternative instructional
method. Nurse Education, 14, 12–16.
11. Henry P. (1993). Distance learning through audioconferencing. Nurse Education, 18, 23-26.
12. Hardy D.W., Olcott Jr. D. (1995). Audioconferencing and the adult learner: Strategies for effective
practice. American Journal of Distance Education, 9, 44–60.
13. Clark C.E. (1989). Telecourses for nursing staff development. Journal of Nursing Staff Develop-
ment, 5(3), 107–110.
14. Boyd S., Baker C.M. (1987). Using television to teach. Nursing and Health Care, 8, 523–527.
15. Heidenreiter T.J. (1995). Using videoteleconferencing for continuing education and staff develop-
ment programs. Journal of Continuing Education in Nursing 26, 135–138.
16. Maltby D., Drew L., Andrusyszyn M.A. (1991). Distance education: Joining forces to meet the
challenge. Journal of Continuing Education inNursing, 22, 119–122.
17. Billings D., Bachmeier B. (1994). Teaching and learning at a distance: A review of the nursing lit-
erature. In: Allen L.R. (Ed.). “Review of research in nursing education”, New York, NY: National
League for Nursing. pp. 1–32.
18. Parkinson C.F., Parkinson S.B. (1989). A comparative study between interactive television
and traditional lecture course offerings for nursing students. Nursing and Health Care, 10,
499–502.
19. Keck J.F. (1992). Comparison of learning outcomes between graduate students in telecourses and
those in traditional classrooms. Journal of Nursing Education, 31, 229–234.
Chapter 04.indd 79 5/18/2012 11:41:57 AM

20. McClelland E., Daly J. (1991). A comparison of selected demographic characteristics and
academic performance of on-campus and satellite-center RNs: Implications for the curriculum.
Journal of Nursing Education, 30, 261–266.
21. Sharon W. Tabor. (Spring 2007). “Narrowing the distance: implementing a hybrid learning mod-
el. Quarterly Review of Distance Education (IAP), 8(1), 48–49. ISSN 1528-3518. http://books.
google.com/books?id=b46TLTrx0kUC. Retrieved 23 January 2011.
22. Dr Norman D. Vaughan. (2010). Blended learning. In: Cleveland-Innes M.F., Garrison D.R. “An
introduction to distance education: Understanding teaching and learning in a new era”, Taylor
& Francis. p. 165. ISBN 0415995981. http://books.google.com/books?id=AI5as0yooGoC. Re-
trieved 23 January 2011.
23. Michael G. Moore, Greg Kearsley. (2005). “Distance education: A systems view, 2nd edition,
Belmont, CA: Wadsworth.
24. Coombs P. H., Ahmed M. (1974). “Attacking rural poverty. How non-formal education can help”,
Baltimore: John Hopkins University Press.
25. Jeffs T., Smith M.K. (1996, 2005). “Informal education. Conversation, democracy and learning”,
Ticknall: Education Now.
Chapter 04.indd 80 5/18/2012 11:41:57 AM

c h a p t e r 5
Teaching–Learning Process
1. INTRODUCTION
It is a well-established belief among educationists that learning is the outcome of teaching, and
teaching is aimed to facilitate learning. Here, the questions arise that, whether teaching is man-
datory for learning to take place? Is learning always dependent on the teaching? The answers to
these questions lie in the fact that, teaching is not a must for learning to take place and, learning
is not always dependent on the teaching. However, in the context of academic education, teaching
is considered as a mandate to facilitate learning among students and learning is the direct outcome
of teaching. Teaching and learning both go hand in hand, they are the two sides of the same coin.
Teaching and learning are two fundamental aspects of educational process, which are closely re-
lated to each other; one cannot be separated from the other. The most important objective of teach-
ing is to facilitate learning; therefore, the concept of teaching is incomplete without learning. For
understanding the teaching–learning process, it is essential to study the nature of teaching and
learning.
2. DEFINING TEACHING
Teaching simply refers to the act of imparting instructions to the learners or students in either clini-
cal or classroom situation, which ultimately leads to acquisition of the knowledge, skill, and attitude
on the part of the learner. It is a process in which teacher, learner, classroom/clinical environment,
curriculum/content along with some other factors interact in a systemic and organized way to attain
predetermined goals. Let us see how the great educationist and psychologists defined the teaching in
different ways.
Burton defines “Teaching is the stimulation, guidance, direction, and encouragement of learning.”
Thomas F. Green defines “Teaching is the task of teacher which is performed for development of a
child.”
Edmund A. defined “Teaching is an interactive process, primarily involving class-room talk which
takes place between teacher and pupils and occurs during certain definable activities.”
B.F. Skinner interpreted the meaning of teaching as arrangement of contingencies of reinforcement
under which students learn. They learn without teaching in their natural environment, but teachers
arrange special contingencies that expedite learning and hastening the appearance of behavior which
would otherwise be acquired slowly or making scene of the appearance of behavior which might
otherwise never occur.
Chapter 05.indd 81 5/18/2012 11:42:51 AM

The best learners... often make the worst teachers. They are, in a very real sense, perceptually
challenged.
They cannot imagine what it must be like to struggle to learn something that comes so naturally
to them.
—Stephen Brookfield
N.L. Gage defined “Teaching is an act of interpersonal influence aimed at changing the ways in
which other persons can or will behave.”
For a professional teacher or teacher trainee, teaching is simply the delivery of the subject content as
per lesson plan by using appropriate instructional method (lecture, demonstration, and role play) and AV
aids as per the requirement of the curriculum to achieve the desired learning objectives.
3. CONCEPT OF TEACHING
The concept of teaching is quite complex; therefore, for the purpose of clear understanding of this con-
cept, it can be broken down into the following headings:
Planned activity: Teaching is an activity that requires rigorous planning on the part of teacher. With-
out good planning, aims of the teaching cannot be achieved.
Tripolar process: Teaching activity turn around the three main poles: teacher, learner, and content.
These three poles interact in a systematic and organized way, aiming to facilitate learning.
Interactive process: Teaching stimulates interaction between the teacher and learner in the con-
text of curriculum, which will activate the students mentally and physically, resulting in effective
learning.
Motivation to learn: Teaching is an activity that is intended to motivate the learner to learn.
Art as well as science: Teaching is both an art and a science. As an art, it requires mastery of certain
skills by the teacher to deliver efficient teaching. As an artist, a teacher has to deal with raw materials
to develop it in a desired shape. He/She is a creative agent who transforms a part of himself/herself into
the child and mirrors himself/herself into the child. Teaching is also considered as a science, because
the skills of teaching can be systematically studied, observed, and improved scientifically with the help
of research. It requires special type of training (B.Ed., M.Ed. or study of education as a separate subject
in B.Sc. and M.Sc. Nursing) to be a professional teacher. There are certain principles that underline the
science of the teaching, that is, principle of reinforcement and principle of active participation of the
students. Teaching is also governed by some underlying theories that are essential for any scientific
profession. It is well said that, “an expert cannot be a good teacher and a good teacher may not be an
expert.” Therefore, teaching is not a separate entity, rather it is a blend of both art and science.
Communication: During teaching–learning process, the teacher has to communicate the information,
facts, and knowledge to the students.
Guidance: Teaching is type of guidance that is provided by the teacher to the students. The teacher
acts as a guide to the student to overcome the various learning difficulties faced by the student.
Teachers who cannot keep students involved and excited for several hours in the classroom
should not be there
—John Roueche
Chapter 05.indd 82 5/18/2012 11:42:51 AM

Teaching–Learning Process | 83
This type of teaching is appropriate for play or primary school students

to shape their habits and behaviour. It can be useful in professional
Conditioning
education (nursing) to reshape the behaviour of the students as per
the requirement of the profession
Training It is useful type of teaching for school-going children. The purpose of

this type of teaching is to shape the conduct and skills of the students.
This is type of teaching is advantagious for undergraduate and

postgraduate student. It involves imparting or communicating
knowledge or information to the students. Training is prerequisite for the
Instruction success of this teaching strategy. The teacher, while using this type of
teaching should have good reasoning capacity and in depth thinking
so that he can satisfy the needs of higher level of the students.
This type of teaching is required to teach Ph.D. nursing students where

teacher is supposed to shape the beliefs of the nursing scholars.
Indoctrination
Indoctrine requries highest level of intelligence and reasoning
capacity on the part of the teacher.
Figure 5.1 Types of Teaching
Types of teaching: There are four types of teaching that can be used at different levels of education/
development of the student (see Figure 5.1).
4. PRINCIPLES OF TEACHING USED IN NURSING EDUCATION

4.1. Principle of Activity or Learning by Doing
Principle of activity emphasizes that the students should be actively involved in teaching–learning pro-
cess. Research has shown that if the students are active mentally and physically during teaching session,
the teaching will become efficient and effective in terms of student learning. Teaching can be facilitated
if the students actively participate in the learning process and learn while actually manipulating (doing)
the things to be learnt.
Chapter 05.indd 83 5/18/2012 11:42:52 AM

4.2. Principle of Goal Setting

Teaching is a planned activity and the learning objectives are the driver of this activity which controls
the direction and methodology of the teaching. Therefore, goal setting is a vital part of teaching. Any
teaching without preplanned learning goals or objectives is useless and becomes flawed.
4.3. Principle of Stimulation

This principle implies that teaching should stimulate the learner to think, to explore, and to seek more
information that will ensure the active involvement of the students in teaching–learning process and
lead to better learning.
4.4. Principle of Association

Principle of association highlights the importance of association of related concepts from different sections
of the curriculum; for example, while teaching medical surgical nursing a teacher has to associate the con-
cepts of pathology and physiology to explain the pathophysiology of the particular disease. The association
of concepts should be gradual and continuous that can lead to integrated learning and better understanding.
4.5. Principle of Exercise or Repetition

This principle of teaching focuses on the need of exercises of the subject matter taught by the teacher.
At the end of the teaching, the teacher should assign some activity (assignment) to the students that will
prove to be helpful for better retention of learning. Teaching should be repeated as and when required,
for example, the majority of the students have not learnt the complex concept.
4.6. Principle of Feedback and Reinforcement

This principle of teaching focuses on the immediate feedback and reinforcement to the learner about the
learning. Feedback and reinforcement acts as a boost to learning.
4.7. Principle of Group Dynamics

Principle of group dynamics is important while teaching in small group-by-group discussion method. A
teacher must utilize the principles of group dynamics and group-forming strategies to make the discus-
sion organized and fruitful.
4.8. Principle of Creativity and Recreation

An ideal teaching must not be mind-numbing to the students. When the teacher feels that students are
getting bored during the lecture, he/she should stimulate the students by a brief recreational activity or
stretching exercises. He should use creative ways of teaching for those lessons in which students are
likely to get bored. At the same time, a good teaching should stimulate creativity among the students
that is satisfying to the needs of the students.
Every truth has four corners: as a teacher I give you one corner, and it is for you to find the other
three
—Confucius
Chapter 05.indd 84 5/18/2012 11:42:52 AM

5. MAXIMS OF TEACHING
Maxims of the teaching are the guidelines or rules that should be followed so that it will be easy for the
students to comprehend the concepts or terms. They have proven to be valuable in obtaining the active
participation and involvement of the learner in the teaching–learning process.
If followed carefully during teaching, it leads to effective, interesting, meaningful, and goal-oriented
learning. They arouse the interest of the learners in learning and help to motivate them to learn. A good
and intelligent teacher should be familiar with them. They are as follows:
5.1. Proceed from the Known to the Unknown

This maxim of teaching emphasizes that new knowledge cannot be grasped in isolation; therefore,
teacher should proceed from previously familiarized concepts (known) to those information or knowl-
edge that is new for the students (unknown). What the students already know about a subject matter can
be used to arouse interest in a lesson by probing questions related to that area. The teacher then should
proceed gradually step by step to connect the new information to the old one. For example, while ex-
plaining the term hyperthermia, the teacher should probe a question “what is the normal temperature of
the body?
5.2. Proceed from Simple to Complex

Simple concepts should be taught first followed by the complex concepts. It will ease the learning pro-
cess as well as stimulate the students to explore the complex concepts if they have already learned the
simple one.
5.3. Proceed from Easy to Difficult

In determining what is easy and what is difficult, we have to take into account the psychological make-
up of the nursing students. A particular nursing skill may be easy if it is seen from logical point of view;
however psychologically it may be difficult for the students. Therefore, the teacher has to judge first
what is psychologically difficult for the students and then proceed from easy skills to difficult one. For
example, teaching basic nursing skills first and then proceeding to advanced skills (teaching basic life
support first, then advanced cardiac life support).
5.4. Proceed from the Concrete to Abstract

This is a particularly important maxim of the teaching for nursery or primary school students; however,
it can also be utilized to teach nursing students. It highlights that a teacher should first use concrete
material to stimulate learning among students as it is easy to learn with the help of concrete material;
thereafter, he/she should proceed to abstract description of the contents. For example, show the model
of the heart first, then proceed to explain the anatomy of the heart.
5.5. Proceed from Particular to General

Teaching should proceed from particular or specific facts to general facts. It is easy to understand the
things for the students if specific facts precede the general facts. Study of particular or specific facts
should lead the students themselves to frame general rules.
Chapter 05.indd 85 5/18/2012 11:42:52 AM

5.6. Proceed from Indefinite to Definite

Teaching should proceed from unclear, vague, or blurred facts to more clear and definite facts or in-
formation. These vague or indefinite ideas will create a platform on which explicit, clear-cut, or exact
information can be presented that will be easily grasped by the students.
5.7. Proceed from Empirical to Rational

Observation and experience in clinical areas are the basis of empirical knowledge for nursing under-
graduates. This empirical knowledge is quite easy to retain as it is concrete learning. Rational knowl-
edge is abstraction and argumentative approach for learning. This maxim of teaching signifies that the
student should experience the knowledge in his day-to-day life first; thereafter, he/she should make
rational basis for that knowledge. The teacher should present empirical facts first, which are concrete
and then proceed to abstract area of the content.
5.8. Proceed from Psychological to Logical

Teacher should take into consideration the interest of the students, their needs, and reactions (psycho-
logical) on priority basis. Logical approach is concerned with systematic arrangement of the contents
that is coherent and valid. Teaching logically means the teacher is thinking of it from his/her own point
of view and not psychologically from the point of view of the child.
5.9. Proceed from Whole to Part

Guildford JP, Newman, and Seagoe conducted research studies and concluded that the “whole” ap-
proach is better than “part” learning because the content to be learnt “makes sense,” and its part can be
seen by the learner as interrelated. Whole is more meaningful to the child than the parts of the whole.
For example, initially a nursery child is taught full poem which is easy for him/her to learn, then he/she
is explained the poem line by line.
5.10. From Analysis to Synthesis

Teaching should proceed from analysis to synthesis of problem or content. Analysis means dividing
or disintegrating a problem or content into parts for teaching and synthesis means clubbing together
of these parts into one complete problem. When teacher is dealing with a complex problem or content
which is difficult for the students to understand, it is better to divide the problem in parts that are easy to
understand; thereafter, these parts can be synthesized to make actual problem or content.
5.11. From Actual to Representative

Actual objects make the learning easy to the students as well as the retention of learning is better and
long-lasting. Actual objects should be used initially and when the students become familiar with actual
objects it can be replaced with representative models, chars, or pictures for further/future learning. For
example, to teach human anatomy to B.Sc. nursing first-year students, it is better to show them dead
body dissection first to explain the structure of various body parts; thereafter, charts and models can be
used for subsequent classroom teaching.
Chapter 05.indd 86 5/18/2012 11:42:52 AM

5.12. Proceed from Induction to Deduction

In inductive approach of teaching, examples are quoted first; afterward, students are encouraged to
participate actively to draw general rules from these examples. In the deductive approach, the teacher
explains the definition or general rules first; afterward, students are asked (or sometime teacher himself/
herself) to quote some examples applying the taught definitions or concepts.
From the above-listed teaching maxims, it is clear that they are meant to suit different teaching–learning
situations. It is, therefore, essential that a judicious use should be made of each maxim as per the require-
ment of the lesson and the developmental stage of the students. They are only the means and not the end.
No man can be a good teacher unless he has feelings of warm affection toward his pupils and a
genuine desire to impart to them what he himself believes to be of value
—Bertrand Russell
6. CONCEPT OF LEARNING
Learning is the lifelong process, which starts from the womb and ends to the tomb. It is worth mention-
ing here the mythological story of Mahabharata in which Abhimanyu learnt the technique to enter in to
the Chakravhyu when he was in the womb and his father Arjuna was telling the story of Chakravhyu to
his mother. Learning is an intangible idea which has been interpreted differently by many psychologists
and educationists. In our day-to-day life, we interpret and transform information and experience into
knowledge, skills, behaviors, and attitudes, and this is referred as learning.
Learning is acquisition of new facts, information, knowledge, skills, attitude, and values. It results in
change or modification of the behavior of the learner that is observable and measureable.
Learning may be the effect of specific training, observation, education, and social interaction. When
we use the term learning in the context of academic education, it is referred to goal-oriented learning
aiming to modify the behavior of the learner in the desired direction.
Learning is an abstract idea or concept that refers to the acquisition of the new knowledge, informa-
tion, skill, and value that can be concretely represented by observable modifications in behavior and
attitude of the learner.
Gates defined “Learning is modification of the behavior through experience.”
Crow and Crow defined “Learning involves the acquisition of habits, knowledge, and attitudes.”
Woodworth defined “The process of acquiring new knowledge and new response is the process of
learning.”
Saljo (1979) conducted a research study in which he asked a number of adult students what they
understood by learning. Responses provided by the sample were categorized into five categories:
❑❑ Learning as a quantitative increase in knowledge. Learning is acquiring information or “knowing

a lot.”
❑❑ Learning as memorizing. Learning is storing information that can be reproduced.
❑❑ Learning as acquiring facts, skills, and methods that can be retained and used as necessary.
❑❑ Learning as making sense or abstracting meaning. Learning involves relating parts of the subject
matter to each other and to the real world.
❑❑ Learning as interpreting and understanding reality in a different way.
Chapter 05.indd 87 5/18/2012 11:42:52 AM

Every act of conscious learning requires the willingness to suffer an injury to one’s self-esteem.
That is why young children, before they are aware of their own self-importance learn so easily;
and why older persons, especially if vain or important, cannot learn at all–
—Thomas Szasz
7. NATURE OF THE LEARNING: LEARNING THEORIES

In order to explain how or why change or modification in behavior occurs as a result of learning,
few psychologists and educationists have proposed learning theories. Each learning theory has its own
orientation to explain the how of learning. On the basis of orientation, the important learning theories
can classified into four groups (Merriam and Caffarella, 1991) as follows:
❑❑ Behavioristic learning theories
❑❑ Cognitive learning theories
❑❑ Humanistic learning theories
❑❑ Social or situational learning theories
7.1. Behavioristic Learning Theories

Behavioristic oriented learning theories were proposed by great psychologists B.F. Skinner, Pavlov,
Thorndike, Tolman, and Watson. Behaviorism is a psychological movement, which accentuated on ar-
rangement of the environment to bring out successful modification in behavior and to arrange corollary/
consequences to maintain or diminish behavior. Behavioristic learning theorists viewed the learning pro-
cess as change in behavior of the individual and believed that the stimuli in the external environment are
the locus of learning. The role of teacher according to these theories is manipulation or arrangement of the
environment so that the desired response can be elicited from the learner. Learning takes place as a result
of the interaction between learner and environment. A learner has to respond to the given environment
and his/her response is manifested by his/her behavior. The educational objectives or learning objectives
should be stated in behavioral terms that will provide basis for the assessment of the learning. The purpose
of the education is to produce change in the behavior of the learner in the prespecified direction.
7.2. Cognitive Learning Theories

Cognitive-oriented learning theories were proposed by cognitive psychologists Jean Piaget, Koffka,
Lewin, Bruner, and Gagne. They believed that the internal cognitive structures of human being are
the locus of learning. They viewed the learning process as internal cognitive/mental process, which
includes memory perception, information processing, etc.; furthermore, they believed that the purpose
of the education should be strengthening these mental processes and developing capacity and skills of
the students to learn better. Teacher has to play an important role in structuring the content of learning
activity, which can stimulate cognitive structures of the student.
7.3. Humanistic Learning Theories

Abraham Maslow and Rogers were among the proponents of the humanistic learning theories. The
humanistic view of learning theories emphasize that learning occurs because of affective and cognitive
Chapter 05.indd 88 5/18/2012 11:42:52 AM

needs of human being. Learning process is a personal act to fulfill the potential of an individual.
According to this orientation, the purpose of education is to make the individual self-actualized and
autonomous so that, he/she can fulfill or explore his/her potential. A teacher has to play an important
role to facilitate the development of the whole person. Andragogy and self-directed learning is the ex-
pression of humanistic orientation in adult education.
7.4. Social or Situational Learning Theories

Bandura, Lave, and Wenger and Salomon were among the proponent of social or situational learning
theories. Learning is social and occurs due to interaction or observation in social contexts. It is a move-
ment from the periphery to the centre of a community of practice. Relationship between people and en-
vironment forms the locus of learning. The purpose of education should be encouraging the students for
full participation in communities of practice and utilization of resources. Teacher’s role is to establish
communities of practice in which students can have conversation and participation.
From the above-cited discussion of the theories, it is obvious that these learning theories involve
different ideas to explain learning, locus of learning, purpose of education, and the role of the teacher.
8. CHARACTERISTICS OF THE LEARNING

❑❑ Learning is adjustment: Learning helps the individual to adjust properly in a new situation or
new environment.
❑❑ Learning is both individual and social: Learning is not only the individual activity but is a
social activity also. Individual mind is affected by the group mind, as individual is influenced
by his/her friends, parents, relatives, etc. and learn their ideas and feelings. Social agencies like
family and religions have tremendous influences on learner and always mould and remould the
behavior of a person.
❑❑ Learning is purposeful and goal directed: Learning is always having some specific purpose
which is concerned with the use of some inner powers and energy with which persons are en-
dowed with from birth.
❑❑ Learning is always intelligent: When any person learns something unintelligently, he/she will
forget that learned thing very soon and he/she does not gain but simply commits to memory. This
type of learning efforts does not produce any permanent results. Only efforts made intelligently
have lasting effects.
❑❑ Learning is active and creative: The principle of learning by doing highlights that learning is ac-
tive. The Chinese proverb “If I hear, I forget; If I see, I remember; If I do, I know,” also illustrates
that learning is active.
❑❑ Learning is organizing experience: Learning is not merely the act of acquiring of facts and skills
through experience and repetition; rather, it is reorganization of the experience.
❑❑ Learning affects the conduct of learner: The person learns through experience. Therefore, after
every experience, there is a change in the mental structure of the learner that affects the conduct
of learner.
❑❑ Learning depends upon insight: Insight is thorough knowledge or skill. Learning depends upon
insight.
❑❑ Learning is progressive change in behavior: Change or modification in behavior is the
manifestation of the learning.
Chapter 05.indd 89 5/18/2012 11:42:52 AM

❑❑ Learning is universal in nature: All living creations whether human or animal learn throughout
their life.
❑❑ Learning is a never-ending process: Learning starts from womb and ends in tomb. Triumph
motivates for further efforts.
❑❑ Learning is process and not a product.
❑❑ Learning takes place through trial and error.
❑❑ Learning is transferable.
9. TYPES OF LEARNING
Learning can be of different types depending on the developmental stage and mental capacity of the
living being. Some important types of learning are as follows:
9.1. Sensitization and Habituation (Nonassociative Learning)

Sensitization refers to a progressive increase of a response when the stimulus is administered repeat-
edly to the living being (Bell et al. 1995). It is responsible for adaptive as well as maladaptive learning
processes in the human being. On contrary, habituation is a type of nonassociative learning, which is
most commonly present in animals. In this type of learning, there is progressive attenuation of behav-
ioral response when the animal is presented with repeated stimulus. When the stimulus is presented the
first time before the animal, it responds to it appropriately, but if the stimulus is neither gratifying nor
detrimental the animal reduces succeeding responses to it.
9.2. Associative Learning

In associative learning, current teaching content is learnt through its association with a separate, previ-
ously learnt content. This type of learning was explored through the classical conditioning and operant
conditioning experiments on animals conducted by Pavlov and Skinner. Classical conditioning involves
repeatedly pairing an unconditioned stimulus (which consistently produces a reflexive response) with
another neutral stimulus (which does not normally produce that reflexive response). Following con-
ditioning, the animal provides response to both the stimulus (“unconditioned stimulus” and the other
previously neutral stimulus now known as the “conditioned stimulus”). The response to the conditioned
stimulus is termed a conditioned response. The classic example is Pavlov’s experimentation with dog’s
salivation. On contrary, operant conditioning is based on the use of reinforcement or punishment to
modify the occurrence and form of behavior.
9.3. Observational Learning

Observational learning is based on imitation. A child learns by observing his/her parents’ activities and
try to imitate these. Similarly, a student-nurse observes staff nurses performing nursing procedures and
care of the patients in clinical area, and she learns a number of nursing skills by imitating what she has
observed. It is therefore necessary that staff nurses and nursing faculty should act as a role model be-
cause students learn by observing them.
9.4. Enculturation
It is the process by which a person learns his native culture. This process helps the individual to learn
and acquire those social skills, values, and behaviors that are necessary in that culture. It ensures
Chapter 05.indd 90 5/18/2012 11:42:52 AM

c ompetence in the mother language, values, traditions, social interaction, and rituals of the culture.
Similarly, a nurse-student learns nursing culture through this process.
9.5. Multimedia Learning

Multimedia learning is based on the use of auditory and visual media to learn information.
9.6. E-learning/M-Learning
E-learning is internet-based learning, which is facilitated by the use of computers/3G tabs which are
networked through internet. Nowadays, a similar term is arising that is M-learning, which uses mobile
telecommunication equipments for learning. For example, when a staff nurse encounters a new drug
in her patient’s prescription, she can use her mobile phones to learn immediately about that new drug
either through the software installed in mobile or by connecting with the internet through mobile GPRS.
9.7. Rote Learning

Rote learning is a type of learning in which the student tries to learn the content by repetitively memo-
rizing it without understanding the meaning and inferences of the concept. The purpose of rote learning
is to recall the content in the university examination to write the answer. Once the student writes the
answer in examination, he/she forgets the memorized content within few days. Rote learning has been
criticized by some schools of thought, but it may be a necessity in many situations.
9.8. Informal Learning

Informal learning is related with our experiences of day-to-day life. For example, one would learn not to
immerse finger in boiling water because of obvious risk of burn and pain. Therefore, informal learning
means learning from life which requires no school or no professional teacher; one can learn during play
with peers and talking with parent at the dining table.
9.9. Formal Learning or Learning Conscious

Formal learning takes place in school or college of nursing, which requires a structured curriculum for
study, teacher–student relationship in which the teacher is a facilitator of learning. It is “educative learn-
ing” rather than the accumulation of experience. There is a consciousness of learning among students
that the task they are engaged in entails learning. Learning itself is the task, but the formalized learning
makes learning more conscious in order to enhance it (Rogers, 2003: 27).
9.10. Nonformal Learning

Nonformal learning is an organized type of learning, which occurs outside the formal learning system.
It involves a group of people having similar interest coming together and learning through exchanging
ideas and viewpoints. For example, workshops, conferences, and faculty clubs.
10. LEARNING STYLES

Learning styles are the different ways by which a student or a person tries to learn something. The
important learning styles used by most of the nursing students are depicted in Figure 5.2.
Chapter 05.indd 91 5/18/2012 11:42:52 AM

Visual style: Learning by Physical style: Use of hands,

vision using pictures and sense of touch for learning
spatial understanding
Social style: Learning in group

(society) with other students
Logical style: Learning by Learning
reasoning and logic not by Styles
merely memorizing the things
Aural style: Learning by the use
of sound (e.g., music)
Solitary style: Learning by

self-study (self-instruction Verbal style: Learning by using
module), working alone words in speech and writing
Figure 5.2 Learning Styles
Research shows us that each learning style uses different parts of the brain. By involving more of
the brain during learning, we remember maximum of what we learn. Researchers using brain-imaging
technologies have been able to find out the key areas of the brain responsible for each learning style.
10.1. Kolb’s Learning Styles Model

Kolb’s learning theory proposes that different people prefer a single different learning style that is based
on the developmental stage of that individual. Kolb’s model of learning styles (1984) proposed four dis-
tinct learning styles that are based on a four-stage learning cycle. Four-stage learning cycle is the central
principle in Kolb’s learning theory, which includes “immediate or concrete experiences” that leads to
“observations and reflections.” These “observations and reflections” are translated into “abstract con-
cepts,” which in turn provides implications for action which can be “actively tested,” thus creating new
experiences for an individual.
Kolb’s model proposed four-stage cycle of learning and four-type definitions of learning, which are
given in Table 5.1.
Kolb explains that preference of learning style depends on two pair of conflicting variables that can
be presented on two separate continuums.
TABLE 5.1 Four-Stage Cycle of Learning

Four-stage cycle of learning Four-type definition of learning styles
Concrete experience (CE) Diverging (CE/RO)

Reflective observation (RO) Assimilating (AC/RO)
Abstract conceptualization (AC) Converging (AC/AE)
Active experimentation (AE) Accommodating (CE/AE)
Chapter 05.indd 92 5/18/2012 11:42:52 AM

Watching (RO)
Feeling (CE) Thinking (AC)
Doing (AE)
Figure 5.3 Continuum of Kolb’s Learning Style Preference Variables
In Figure 5.3, the east–west axis is perception continuum (our emotional response, or how we think
or feel about it) and the north–south axis is processing continuum (how we approach a task). The com-
bination of these two choices produces a preferred learning style, which can be represented into a matrix
table (Table 5.2).
From the above given matrix table, it can be interpreted that a person with a dominant learning style
of watching rather than “doing” the task and thinking rather than feeling about the experience will have
a learning style of assimilating.
Converging: People with converging learning styles prefer doing and thinking. They are less con-
cerned with interpersonal relations and are more attracted to technical tasks and problems than social
or interpersonal issues.
Accommodating: People with this learning style prefer doing and feeling. They are attracted to new
challenges and experiences without any logical analysis of the situation. This learning style is useful
in roles requiring action and initiative like in emergency ward setting. Nurses with this learning style
prefer to work in teams to complete tasks.
Diverging: The individual of this learning style prefers to watch the task rather than doing it; he/
she prefers to feel it rather than thinking over it. The individual of this learning style performs better in
situations that require ideas generation as he/she tends to be imaginative and emotional.
TABLE 5.2 Learning Style Matrix

Doing (AE) Watching (RO)
Feeling (CE) Accommodating (CE+AE) Diverging (CE+RO)

Thinking (AC) Converging (AC+AE) Assimilating (AC+RO)
Chapter 05.indd 93 5/18/2012 11:42:53 AM

Assimilating: Assimilating learning style means students like to watch task rather than doing it
and thinking over it rather than feeling it. These individuals are better in understanding wide-ranging
information and organizing it in a clear logical format.
11. RELATIONSHIP BETWEEN TEACHING AND LEARNING

Teaching and learning are two different concepts, which in fact are related with each other and go hand
in hand. It is unfair to declare that teaching always leads to learning and for learning teaching is always
required. Learning may occur without any teaching. We learn a lot without any teaching through our
day-to-day experiences, observation, trial and error, and reasoning. Nursing student can learn so many
things by simply observing the staff nurses performing clinical duties. It is well said that a good learner
may not be a good teacher, but a good teacher is always a good learner. In order to be a good teacher, a
teacher has to learn or acquire knowledge of subjects, teaching skills, and so on. It proves that learning
precedes the teaching and at the same time, it is also true that teaching facilitates the learning and makes
it meaningful.
12. EDUCATIONAL AIMS AND OBJECTIVES

Educational aims and objectives provide the framework that regulates the teaching–learning process
and affects the evaluation. Aims and objectives provide direction to the teachers about what to teach,
how to teach and how to evaluate, or assess the student’s learning. Educational aims and objectives
should be clear to learner as well as to the teacher for smooth running of teaching–learning process.
12.1. Determinants of Education Objectives

Educational objectives are determined by:
❑❑ Statement of college’s philosophy
❑❑ Social and health needs of society and resources
❑❑ Services to the patient
❑❑ Level of the professional competence to be attained
❑❑ The student’s background and level of education
❑❑ Statutory minimum requirements
❑❑ The teaching, physical, and clinical resources available
❑❑ Future demands on nursing in relation to advances in technology
❑❑ Expected job responsibilities of difference nursing positions
13. PURPOSES OF EDUCATIONAL OBJECTIVES

❑❑ Serves as a guide in selection of important and desirable subject matter
❑❑ Describes behavior in terms of student performance
❑❑ Indicates direction toward which the behavior is to be geared
❑❑ Provides guidelines for developing assessment tools
Chapter 05.indd 94 5/18/2012 11:42:53 AM

❑❑ Communicates effectively the desired outcomes of instructions to the students, teachers, and
administrators.
❑❑ Students come to know the expected achievement at the end of the course.
❑❑ Helps in evaluation of the course and gives feedback to planners, administrators, and others
concerned about the efficacy of the educational programme.
14. TYPES OF EDUCATIONAL OBJECTIVES

Educational objectives or learning objectives are classified into three types on the basis of specificity
of the objectives.
1. General objectives
2. Intermediate objectives
3. Specific objectives
General objectives
These objectives correspond to the broad general functions of the professionals trained in a school or
college of nursing.
Example:
1. To collaborate with health care team members at all levels for better outcome of the patient.
2. To initiate research activities to improve the clinical nursing practice.
3. To coordinate the educational activities of the students in the clinical areas.
General educational objectives are simply referred to the general functions of a professional nurse.
Since the college of nursing is aimed to produce professional nurses; therefore, the general professional
functions of a nurse will become the general educational objectives of a nursing course.
Intermediate objectives
Intermediate objectives are more specific than general objectives. When the professional functions are
further broken down into professional activities, they are known as intermediate objectives.
Example:
1. To conduct a counseling session on lifestyle modification for diabetes mellitus type II patients.
2. To conduct a health teaching session on “Breastfeeding practice” for postnatal mothers.
Specific objectives
When the professional activities are further broken down into highly specific professional tasks whose
results can be observed or measured against given criteria, these are known as specific objectives.
Example:
1. Place intravenous cannula into a peripheral vein of an adult without hematoma formation and with
not more than two attempts.
2. Collect blood sample from a peripheral vein of a child with not more than two attempts.
3. Deliver a shock of 360 joules from a monophasic defibrillator to an adult cardiac arrest victim after
making sure that everybody along with oxygen is clear from the patient.
Chapter 05.indd 95 5/18/2012 11:42:53 AM

15. QUALITIES OF EDUCATIONAL OBJECTIVES

Specific learning objectives should be:
❑❑ Relevant
❑❑ Logical
❑❑ Unequivocal
❑❑ Feasible
❑❑ Observable
❑❑ Measurable
16. CHARACTERISTICS OF SPECIFIC OBJECTIVE

1. Should be written in behavioral terms
2. Should reflect the condition
3. Should reflect the standard (with what degree of skill)
4. Should be reasonable in a number of behavioral changes expected (4 to 5 for a unit)
5. Should be consistent with the unit theme
6. Should be descriptive
17. CLASSIFICATION OF DOMAINS OF LEARNING OBJECTIVES

Benjamin Bloom has suggested three domains of learning:
❑❑ Cognitive domain: It involves learning in the form of recalling the facts, principles, process, cal-
culation, analysis and interpretation of data, problem solving, etc.
❑❑ Psychomotor domain: This domain focuses on skills that require coordinated movements of body
parts, e.g., chest compression, tepid sponging, oral care, and suctioning. It deals with routine ac-
tions carried out by the student-nurse with a high degree of precision and efficiency and who has
effective control over practical skill.
❑❑ Affective domain: Affect is a persistent disposition to act either positively or negatively toward
a person, group, value, or situation. It focuses on learning of attitude. For example, to like some-
thing, love appreciate, attitude toward HIV/AIDS patient
17.1. Levels in Cognitive Domain

Cognitive domain is further categorized into the following levels:
❑❑ Knowledge—remembering of previously learned content.
❑❑ Comprehension—it is the ability to understand or grasp the meaning of material.
❑❑ Application—it is ability to use learned material in new situation.
❑❑ Analysis—it is the ability to break down material into its component parts.
❑❑ Synthesis—it is the ability to form new whole learning.
❑❑ Evaluation—it is the ability to judge the value of material for a given purpose.
Chapter 05.indd 96 5/18/2012 11:42:53 AM

17.2. Levels of Psychomotor or Cognitive Domain

❑❑ Imitation—student is given demonstration of a procedure step by step and he/she observes.
❑❑ Control—The student practices procedure under supervision.
❑❑ Automatism—A high degree of proficiency is attained and he/she works independently.
17.3. Levels of Affective Domain

❑❑ Receptivity/Attention—willingness to receive
❑❑ Response—sufficient interest in the phenomenon noticed
❑❑ Internalization—it is perception of a phenomenon which affects values
These learning domains are not mutually exclusive categories. For example, to learn basic life support,
firstly, the student will have to learn the algorithm of BLS (cognitive domain); thereafter he has to learn
how to perform chest compression, mouth-to-mouth ventilation, and also how to set up automated ex-
ternal defibrillator (psychomotor). Furthermore, the student may even learn to love the BLS and value
its applications in day-to-day life (affective domain).
18. E LEMENTS OR COMPONENTS OF THE SPECIFIC LEARNING

OBJECTIVES
18.1. Act or Verb
It is the first or starting component of the learning objectives. It is an action verb that represents observ-
able student behavior. The important point in relation to this component is that the action verb must
be observable so that a teacher can make inferences that learning has taken place. Majority of the stu-
dent-teachers commit mistakes in choosing action verb while preparing specific objectives for practice
teaching. For example, students may use the word to appreciate, to understand as action verbs to write
specific learning objectives which aren’t observable phenomenon; therefore, as a student-teacher you
will not be able to infer that learning has taken place. Table 5.3 and Table 5.4 list the verbs that should
and should not be used while framing specific learning objectives for teaching.
TABLE 5.3 Action Verbs that should be Used to Write Learning Objectives
Identify Explain Demonstrate Analyze Enunciate Synthesize Underline
Differentiate Enlist Compare Arrange Enumerate Speak Write
Define Depict Reassure Compare Contrast Justify Verify
Elaborate Illustrate Describe Distinguish Identify Formulate
TABLE 5.4 ction Verbs that should be Avoided

A
to Write Learning Objectives
Know Discuss
Understand Appreciate
Chapter 05.indd 97 5/18/2012 11:42:53 AM

18.2. Content
It is the second component of the learning objective. Content refers to the subject matter, which the
teacher wants the student to learn.
18.3. Criteria
Criteria refer to an acceptable level of performance expected from the student. It is a statement that
specifies how accurately the student must exhibit the behavior. The criteria part of a learning objective
is a declarative statement that describes how well the behavior must be performed to satisfy the intent
of the behavioral verb. Usually, criteria are expressed in some minimum level of performance. For
example, the student will be able to place (act) intravenous cannula in not more than two (criteria) at-
tempts; the student will be able to identify (act) kidney biopsy needle (content) in not more than one
attempt (criteria) among the group of various needles.
18.4. Condition
Condition is the last component of the learning objectives, which describes the conditions under which
the behavior is to be performed. It specifies the circumstances, materials, and directions that the student
is provided to initiate the behavior or the context in which the behavior is supposed to be performed or
shown. For example, the B.Sc. nursing, the first-year student will be able to administer intramuscular
injection at the right place on the right thigh in nursing foundation laboratory on the pediatric manikin
(condition).
19. WRITINGS OF EDUCATIONAL OBJECTIVES

Properly constructed learning objectives specifies indented observable behavior a student must demon-
strate after teaching, so that, the teacher can infer whether learning has taken place or not. Since learning
cannot be seen directly as it is an abstract phenomenon, the teacher has to infer indirectly about learning
from the behavior or actions of the students he/she can observe and measure. A well-constructed learn-
ing or educational objective describes an intended learning outcome and contains three or four parts as
mentioned above.
Examples: Learning objectives (topic for teaching: diarrhea)
1. Cognitive domain
At the end of the class, the students of B.Sc. nursing II year will be able to:
❑❑ Define diarrhea as per WHO definition
❑❑ Elaborate symptoms of diarrhea in children as stated in WHO module.
❑❑ List signs of dehydration in children as stated in WHO module.
2. Psychomotor domain
❑❑ Demonstrate preparation of ORS in home setting.
❑❑ Demonstrate reconstitution of WHO-packed ORS solution.
3. Affective domain
❑❑ Recognize the anxiety of parents of a child having diarrhea
Chapter 05.indd 98 5/18/2012 11:42:53 AM

20. COMPETENCY-BASED EDUCATION (CBE)

20.1. Concept and Definition
CBE emerged in the United States in the 1970s and refers to an educational movement that advocates
defining educational goals in terms of precise measurable descriptions of knowledge, skills, and
behaviors possessed by the students at the end of a course of study (Richards and Rodgers). It was de-
fined by the U.S. Office of Education (1978) as a “performance-based process leading to demonstrated
mastery of basic and life skills necessary for the individual to function proficiently in the society.”
It involves shift of focus of nursing education from what nursing faculties or academicians believe
under- or postgraduate nursing students need to know (teacher focused) to what students need to know
and be able to do in varying and complex clinical, teaching, and administration situations (student and/or
workplace focused). CBE emphasizes on what the students are expected to do rather than what they are
expected to learn. It closely correlates itself with the changing needs of society, students, and teachers.
CBE is focused on competencies that are related to workplace needs, as defined by employers and
the profession. It takes into consideration the expectations of the employer from a nurse as well as how
the profession envisages a professional nurse. It is a functional approach to education that emphasizes
life skills and evaluates mastery of those skills according to the leaner performance. Large skill sets are
broken down into competencies, which may have sequential levels of mastery. Competencies reinforce
one another from basic to advance as learning progresses.
Competencies refer to the nursing student’s ability to apply basic and advanced nursing skills, knowl-
edge, and attitude which is required for everyday life of a professional nurse. Competencies consist of
a description of the essential skills, knowledge, attitudes, and behaviors that are required for a profes-
sional nurse for effective performance of a real-world task involved in the care of patients in clinical
or community area. Competencies may also include the common social skills needed to be successful
members of families, the community, and the workplace.
20.2. Development of Competency-Based Education Programs

Development of CBE requires specific, measurable competency statements that are considered compul-
sory for an ideal professional nurse. These statements reflect the task of a nurse or the expectations of
the employers from nurses. Content of the education programme is selected or developed on the basis of
learner competencies. Students continue the program until they demonstrate mastery of the desired skills.
20.3. Challenges in Competency-Based Education

Competencies within different contexts may require different bundles of skills, knowledge, and atti-
tudes. The challenge is to determine which competencies can be bundled together to provide the optimal
grouping for performing tasks. Another challenge is designing learning experiences that support students
as they practice using and applying these competencies in different contexts. A variety of instructional
techniques, planned group activities, texts, media, and real-life materials can also be useful to teach the
contents of CBE. Students are provided with immediate feedback on assessment performance as it is
a powerful reinforce for learning. Instructions are paced as per requirement or the need of the learner.
CBE often necessitates more complex assessment involving portfolios, experiential learning assess-
ment in field experience, demonstration in varying contexts, role play, and use of standardized patients
or clients; therefore this requires considerable efforts and resources to plan and implement CBE in nurs-
ing educational system in India.
Chapter 05.indd 99 5/18/2012 11:42:53 AM

21. OBJECTIVE-BASED EDUCATION (OBE)

21.1. Concept and Definition
OBE is a method of curriculum design and teaching that focuses on what students can actually do after they
are taught. OBE takes into consideration the final outcomes of an education programme on priority basis as
compared to learning objectives in traditional educational system. For example, the traditional educational
model in nursing focuses on the learning objectives as a first step of educational process, which are taught
by the teachers in the hope that at the end of the course or training, student-nurses will be converted into
professionally competent nurses who have adequate knowledge of diseases, diagnostic tests, interpersonal
skills, communication skills, basic nursing procedures, advance nursing procedure, managerial skills, and
so on. On the contrary, OBE takes into consideration as a first step of education process these final outcomes
of a traditional educational system so that it can be ensured that the final product (professional or registered
nurse) will definitely have these desired expectations that may not be possible with the traditional education
model. OBE addresses the questions like what do you want the students to learn? Why do you want them to
learn it? How can you best help students learn it? How will you know what they have learnt?
The process in OBE is reverse of that associated with traditional educational process. The desired
outcome is selected first and the curriculum, teaching materials, and assessments or evaluation are
planned to obtain the intended outcome (Spady, 1988). All curriculum and teaching decisions are made
based on how best to facilitate the desired final outcomes.
Towers (1996) listed four points for the OBE system that are necessary to make it work:
1. What the student is to learn must be clearly identified.

2. The student’s progress is based on demonstrated achievement.
3. Multiple instructional and assessment strategies need to be available to meet the needs of each student.
4. Adequate time and assistance need to be provided so that each student can reach the maximum
potential.
21.2. Need of Objective-Based Education in Nursing

OBE is sufficiently equipped to assess “what the students are capable of doing,” which the traditional
education system of nursing often fails to do. Since nursing is a profession that deals with life and death
issues, it requires highly competent professional nurses. If the education system of nursing is not sound
enough to evaluate the competency of a student nurse, it is unfair to the society to which we are answer-
able. OBE requires the students to understand the contents by “extending the meaning of competence
far beyond that of narrow skills and the ability to execute structured tasks in a particular subject area’’
(Spady, 1995). OBE puts demand on the student that he/she has to demonstrate nursing skills through
more challenging tasks like writing project proposals and completing the projects, case presentations
in clinical areas, and analyzing case studies. Such challenging tasks require nursing students to think
critically, make decisions, and give presentations.
21.3. Characteristics of Objective-Based Education

❑❑ There is a clear focus on learning outcomes.
❑❑ It recognizes that all students can succeed.
❑❑ It provides with opportunities to students for self-assessment.
Chapter 05.indd 100 5/18/2012 11:42:53 AM

❑❑ There is a learner-centered approach to learning and teaching.

❑❑ It values the different backgrounds, interests, prior experiences, and learning styles of students.
❑❑ Students are provided with opportunities to progress and demonstrate learning outcomes in more
than one context.
❑❑ There is sufficient flexibility in the curriculum to cater for the different characteristics and learning
needs of students.
❑❑ Planning of experiences that promote learning and of assessment occurs at the same time.
❑❑ Assessment is seen as a learning opportunity.
21.4. Principles of Objective-Based Education

21.4.1. Clarity of Focus About Outcomes
The focus of OBE is on outcomes, which influences all the steps of educational process.
21.4.2. Backward Designing of Curriculum

Curriculum is designed by backward approach as compared to traditional educational model by select-
ing outcomes first, then deciding on teaching material and methods, and assessment strategies.
21.4.3. Consistent, High Expectations of Success

Expect students to succeed by providing them encouragement to engage deeply with the issues they are
learning and to achieve the high challenging standard (Spady, 1995).
21.4.4. Expanded Opportunity

There is scope to every learner to learn in his/her own pace. OBE satisfies individual student’s needs
and differences. For example, expansion of available time and resources so that all students succeed in
reaching the exit outcomes.
22. I NSTRUCTIONAL DESIGN: NEED AND IMPORTANCE OF THE

L ESSON PLAN
Lesson plan is a detailed description or blue print of the course of instruction for a particular lesson. Les-
son plan is developed by the teacher which enables him/her to treat the lesson in a more organized and
systematic way; it helps him/her to anticipate the teaching material and to select appropriate method of
instruction, AV aids, type of evaluation, and assignment. Lesson plan is mandatory to plan and deliver
effective teaching to facilitate learning.
As a beginning teacher, you are asked to write lesson plans for your practice teaching because it is com-
pulsory to write lesson plan but at the same time you may observe that senior nursing faculty teaching you
is not using written lesson plans. You may raise question if it is ideal to write lesson plan before every teach-
ing, then why nursing faculty is not writing it? The answer to this question lies in the fact that lesson plan
may or may not be written; with the increased teaching experience the faculty may not have need to write it,
but certainly they have mental sketching for each lesson. On the contrary, you as a student teacher are asked
to write it because you are learning this teaching skill, which is very important to be an effective teacher.
Lesson planning is a special skill that requires practice to get expertise in it. It is a core teaching skill
that each teacher must learn. All nursing teachers must develop and practice this fundamental teaching
skill, although execution of this skill in actual teaching may require some time.
Chapter 05.indd 101 5/18/2012 11:42:53 AM

The purpose of a lesson plan is to communicate to yourself as a teacher about the learning objectives
that will guide you about prerequisite knowledge of the students, what to teach, how to teach, how to
know that learning has taken place and how to evaluate the students, which type of AV aid is suitable for
teaching this particular content, and so on.
22.1. Planning and Designing the Lesson: A Practical Approach

22.1.1. Preplanning Activities
Planning for lesson plan begins when you are assigned a topic for teaching to a particular group of
students. First, you have to refer the syllabus and search for that unit in which this particular topic is
grouped and calculate the time requirement for that topic on the basis of hours allocated to the unit of
instruction. Identify the level of students (ANM/GNM/B.Sc./M.Sc.) so that you can adjust the breadth
and depth of the content. Keep in mind the size of group and the resources available at the institution
level so that appropriate teaching methodology can be selected that is suitable for the particular lesson.
22.1.2. Formulating Learning Objectives

Keeping in mind the curriculum objectives, general and specific learning objectives are formulated for the
lesson. A learning objective is the heart of a lesson plan. These learning objectives should be formulated
carefully because they play a significant role in determining the success of a teaching. It is a description of an
intended learning outcome and is the basis for the entire lesson. They determine rationale for what you and
your students will be engaged during class time. General objective is broad in nature, whereas specific ob-
jectives are highly specific, observable, and measurable, which provides criteria for constructing an assess-
ment for the lesson as well as for the instructional procedures the teacher designs to implement the lesson.
22.1.3. Determine Prerequisite Knowledge of the Students

It is always better to know prerequisite knowledge that is necessary to implement the particular content
of interest. The teacher should know in advance the knowledge level of students as it can be useful for
planning a basis of introduction of the new lesson by asking questions from the students.
22.1.4. Planning for each Specific Learning Objective

Each specific learning objective is treated in an organized and systematic way. A teacher has to answer
the following questions:
❑❑ How much time to allocate for each learning objective?
❑❑ What method of instruction to choose for particular learning objective?
❑❑ Which AV aid will be most suitable to deal with particular learning objective?
❑❑ Is selected AV aid available for use?
❑❑ What learning activities are to be expected from student during teaching?
❑❑ How to evaluate the particular learning objective?
❑❑ What questions are to be asked?
❑❑ The learning objectives are arranged in a systematic and organized manner.
22.1.5. Planning for Content for Each Learning Objective

Beginning teachers are advised to carefully select the content required to accomplish a particular specif-
ic learning objective. Teacher should decide the breadth, depth, and comprehensiveness of the content
Chapter 05.indd 102 5/18/2012 11:42:53 AM

according to the level of the students and time allocated for the lesson. For example, if you are teaching
myocardial infarction to GNM students, the depth of the teaching content for this group of students
will be slightly shallow as compared to that for B.Sc. nursing or M.Sc. nursing students. Always refer
standard textbooks or an authentic (reliable and valid) source on the web or the books referred by cur-
riculum committee for content selection.
Take into consideration what students are supposed to learn during the lesson (skill, knowledge, and
attitude). Use one of the following techniques to plan the lesson content based on the learning objectives:
Demonstration (skill): List in detail the sequence of the steps to be performed
Explanation (knowledge): Outline the information to be presented or explained. Also, determine the
sequence in which the information will be presented (refer maxims of teaching)
Discussion: List of key questions to guide the discussion.
Role play (attitude): Script of the play
It is appreciable if the teacher can make some connection of the content to other subjects so that
the lesson plan could be integrated with other subjects. Putting extra efforts into this direction would
integrate related topics.
22.1.6. Planning for Introduction

The teacher has to plan for the introduction of the particular lesson. If it is continuation of the previous
incomplete lesson, then revision or review of the previous part can be a good introduction; sometimes
a teacher can use some brainstorming exercises or can ask questions that the students don’t know about
the lesson. The purpose of introduction is to stimulate curiosity among the students to learn the topic of
interest; therefore, every effort should be put to make the introduction interesting and thought-provok-
ing so that the student will be interested to learn the planned topic. The teacher has to provide answers
to the following questions while preparing for the introduction.
❑❑ How will you introduce the ideas and objectives of this lesson?
❑❑ How will you get students’ attention and motivate them in order to hold their attention?
22.1.7. Preparing AV Aids or Learning Material

Prepare AV aids that are required for teaching a particular lesson. You can use powerpoint slides, trans-
parency, charts, posters, models, dummy, TV, transistor, or any other AV aids depending upon the suit-
ability and availability of that AV aids in your setting. Since the AV aids attract the senses, it should be
attractive and creative and prepared in advance.
22.1.8. Planning for Flow of Teaching Activities

A teacher has to plan and write the step-by-step procedures that will be performed to accomplish the
learning objectives. Prepare broad outlines of the actions that you will be needed to perform while de-
livering the content of the lesson.
22.1.9. Planning for Conclusion or Closure

Conclusion should be a brief, striking, and punching statement that should cover the core of lesson. It
should lead to smooth closure of the lesson.
22.1.10. Summary
Summarization should not be merely listing all the points that you have taught the students. Rather, it
should brief all the important or highlighting points covering the whole lesson.
Chapter 05.indd 103 5/18/2012 11:42:53 AM

22.1.11. Plan for Follow-up Lessons or Activities

A teacher has to decide what learning activities to be suggested for fortification of learning?
Which lesson should be taught next as a follow-up lesson?
22.1.12. Plan for Assignments

A teacher should plan for the type of assignment that will be most suitable for a particular lesson.
Whether assignment should be whole class assignment, workshops, independent work, and so on.
22.1.13. Bibliography
List all the references from where you have selected your content of teaching. Follow the referencing
style suggested by your university or Vancouver style.
22.2. Format of Lesson Plan

Lesson plan can be written in many formats depending on the requirement and experience of the teach-
er. Given below is a format of lesson plan that can be used by student-teachers to exercise the skill of
writing lesson plan.
Identification data
Name of the student-teacher : Ms. Antima Patel
Topic : Rheumatic Heart Disease
Subject : Clinical Nursing II
Duration : 20 min
Date and time : 20.05.12 at 9.00 am
Venue : College LT
Group of students : M.Sc. 1st Year
Number of students : 20 students
Method of teaching : Lecture cum discussion
AV Aids : PPT slides
General objective
At the end of the class teaching and discussion, the students of first-year M.Sc. nursing will be able to
know about rheumatic heart disease (RHD) and apply this knowledge in their clinical posting while
providing patient care.
Specific objectives
At the end of the teaching, the students will be able to:
1. Define RHD.
2. Explain the etiology of RHD.
3. List the modified Jone’s criteria for diagnosis of rheumatic heart fever.
4. Illustrate the pathophysiology of RHD.
5. Explain the cardiac valvular lesions of RHD.
6. List the types of prosthetic heart valves used in patients with RHD.
7. Elaborate the nursing management of client with RHD.
Chapter 05.indd 104 5/18/2012 11:42:53 AM

Specific
Time objective Content T–L Activity Evaluation
1 min Define Introduction to the topic Student-teacher How will you define
rheumatic Definition of RHD introduces the topic, RHD?
heart disease defines, and explains
(RHD) RHD. Students listen
carefully
1 min Explain the The aetiology and risk factors Student-teacher Explain the
etiology of of RHD: explains the etiology etiological factors
RHD ❑❑ Throat infection and risk factors of responsible for
❑❑ Poor living conditions RHD. Students ask RHD
❑❑ Overcrowding questions
2 min List the Modified Jone’s criteria for Student-teacher List five major
modified diagnosis of rheumatic heart lists the modified modified Jone’s
Jone’s criteria fever: Jone’s criteria criteria for the
for diagnosis ❑❑ Major criteria for diagnosis of diagnosis of RHD
of rheumatic ❑❑ Minor criteria rheumatic heart
heart fever fever. Students
listen carefully,
take notes, and ask
questions
2 min Illustrate ❑❑ Pathophysiological Student-teacher Illustrate the
patho- s equence of RHD illustrates the pathophysiological
physiology of ❑❑ Line diagram of the pathophysiological sequels of RHD
RHD. pathophysiology of RHD sequence of RHD.
Students listen
attentively
6 min Explain Cardiac valvular lesions of PPT showing the List three
the cardiac RHD: cardiac valvular signs of aortic
valvular ❑❑ Mitral stenosis lesions of RHD. regurgitations
lesions of ❑❑ Mitral regurgitation Students ask
RHD ❑❑ Aortic stenosis questions and listen
❑❑ Aortic regurgitation attentively
2 min List the types Types of prosthetic heart Student-teacher lists List two types of
of prosthetic valves: the prosthetic heart prosthetic heart
heart valves ❑❑ Mechanical valves valves. Students listen valves used in RHD
used in ❑❑ Bioprosthesis carefully
patients with
RHD
5 min Elaborate Nursing management of Student-teacher List three priority
the nursing client with RHD: elaborates the nursing diagnosis
management ❑❑ Nursing assessment nursing management for a client with
of client with ❑❑ Nursing diagnosis of client with RHD. RHD
RHD ❑❑ Nursing planning Students contribute
❑❑ Nursing intervention to the discussion and
❑❑ Nursing evaluation suggest interventions
for nursing diagnoses
Chapter 05.indd 105 5/18/2012 11:42:53 AM

1 min To summarize Summary: So far, we have Teacher summarizes

the content discussed about definition, and concludes the
To conclude incidence, various risk factors, topic
the lesson valvular cardiac lesions, and
its management of RHD
(core information should be
attached with each point)
Conclusion: Nurses
working in cardiology
area must understand
the pathophysiological
basis of RHD and provide
individualized nursing care to
the client with RHD
Bibliography ❑❑ Woods S.L., Froelicher E.S., Moytzer S.A., Bridges E.J. (2005) “Cardiac
nursing”, Philadelphia: Lippincott Williams and Wilkins. pp. 756–776.
❑❑ Garcia M.J., Topol E.J., Califf R.M. (2002) “Textbook of cardiovascular
medicine”, Philadelphia: Lippincott Ravens. pp. 579–605.
❑❑ Black J.M., Jacobs E.M. “Medical surgical nursing”, Pennsylvania: WB Saun-
ders Company;4th edition. pp. 1211–1220.
❑❑ Black J.M., Hawks J.H. “Medical surgical nursing”, St. Louis Missouri: Elsevier,
7th edition. pp. 1612–1622.
❑❑ Lewis Collier. “Medical surgical nursing”, St. Louis Missouri: Mosby, 4th edi-
tion. pp. 1612–1620.
❑❑ Alexander R.W., Robert C.S., Valentine F. (2003). The heart. Philadelphia:
Mcgraw Hill. pp. 1562–1578.
❑❑ Eric G. Butchart, Christa P.J. (2006). “Heart valve disease”, Pennsylvania:
Informa Health Care. pp. 769–778.
Chapter 05.indd 106 5/18/2012 11:42:53 AM

CHAPTER HIGHLIGHTS
❑❑ Learning is the outcome of teaching and teaching is aimed to facilitate learning.

❑❑ Teaching is the stimulation, guidance, direction, and encouragement to facilitate learning.
❑❑ Teaching is a tripolar process as teaching activity rotates around three main poles that are teacher,
learner, and content.
❑❑ There are four types of teaching that can be used at different levels of education. These types
include conditioning, training, instruction, and indoctrination.
❑❑ Principles of teaching help to make the teaching meaningful that facilitates learning.
❑❑ Principle of activity or learning by doing, principle of motivation or interest, principle of individu-
al differences, principle of goal setting, principle of stimulation, principle of association, principle
of exercise or repetition, principle of feedback and reinforcement, principle of group dynamics,
and principle of creativity and recreation are some important principles of teaching.
❑❑ Maxims of the teaching are general rules that should be followed to make teaching interesting and
useful for the learners.
❑❑ Learning is an intangible idea which has been interpreted differently by many psychologists and
educationists.
❑❑ The nature of learning has been described by various learning theories that are behavioristic learn-
ing theories, cognitive learning theories, humanistic learning theories, and social or situational
learning theories.
❑❑ Learning may be of various types, for example, simple nonassociative learning, associative learn-
ing, e-learning, enculturation, rote learning, formal and informal learning, etc.
❑❑ Learning styles are the preferred ways of learning used by different persons differently (e.g.,
visual style, solitary, physical style, etc.)
❑❑ Converging, diverging, accommodating, and assimilating are the learning styles proposed by
Kolb’s learning theory.
❑❑ Educational objectives are of three types: general objectives, intermediate objectives, and specific
objectives.
❑❑ Three domains of learning objectives are cognitive, psychomotor, and affective domain.
❑❑ Act, content, criteria, and condition are the components of the specific learning objectives.
❑❑ CBE is focused on competencies that are related to workplace needs as defined by employers and
the profession.
❑❑ OBE is a method of curriculum design and teaching that focuses on what students can actually do
after they are taught.
❑❑ Lesson plan is a detailed description or blueprint of the course of instruction for an individual
lesson.
EVALUATE YOURSELF
Q 1: Define learning? What are the characteristics of learning? Discuss the nature of learning (NIMS,
2010; NTRUHS, 2007).
Q 2: Discuss briefly the basics of Pavlov’s classical conditioning (MGRUHS, 2010).
Chapter 05.indd 107 5/18/2012 11:42:54 AM

Q 3: Explain the teaching–learning process (RUHS, 2010).

Q 4: Describe the theories of learning (MGU, 2007).
Q 5: Explain the principles of teaching (RGUHS, 2010; RUHS 2010).
Q 6: What are the different types of learning styles? Explain briefly (AIIMS M.Sc. Nursing, 2005).
Q 7: Explain the factors influencing learning? (NTRUHS, 2009).
Q 8: What are the difference between teaching and learning? Explain briefly (NIMS, 2010).
Q 9: What are the learning domains? Differentiate between cognitive and affective domain (MG
University, 2008).
Q 10: Explain the principles of learning (MGU, 2008).
1. Hartley J. (1998). Learning and studying. “A research perspective”, London: Routledge.
2. Hergenhahn B.R., Olson M.H. (1997). “An introduction to theories of learning”, 5th edition, Upper
Saddle River, NJ: Prentice-Hall.
3. Illeris K. (2002). “The three dimensions of learning. Contemporary learning theory in the tension
field between the cognitive, the emotional and the social, Frederiksberg: Roskilde University Press.
4. Joyce B., Calhoun E., Hopkins D. (1997). Models of Learning—tools for teaching, Buckingham:
Open University Press.
5. Merriam, S., Caffarella (1991, 1998) “Learning in adulthood. A comprehensive guide”, San
Francisco: Jossey-Bass.
6. Murphy P. (ed.). (1999). “Learners, learning and assessment”, London: Paul Chapman.
7. Leach J., Moon, B. (eds.). (1999) “Learners and pedagogy”, London: Paul Chapman.
8. Rogers A. (2003). “What is the Difference? A new critique of adult learning and teaching”,
Leicester: NIACE.
9. Gagné R.M. (1985). “The conditions of learning 4e”, New York: Holt, Rinehart and Winston.
10. Jarvis P. (1987). “Adult learning in the social context”, London: Routledge.
11. Kolb D.A. (1984). “Experiential learning”, Englewood Cliffs, NJ.: Prentice Hall. Substantial
discussion of the ideas underpinning Kolb’s well-known model.
12. Piaget J. (1926). The child’s conception of the world”, London: Routledge and Kegan Paul.
13. Rogers C., Freiberg H.J. (1993). “Freedom to learn”, 3rd edition, New York: Merrill.
14. Salzberger-Wittenberg I., Henry G., Osborne E. (1983). “The emotional experience of learning and
teaching”, London: Routledge and Kegan Paul.
15. Saljo R. (1979). “Learning in the learner’s perspective. I. Some common-sense conceptions”,
Reports from the Institute of Education, University of Gothenburg, 76.
16. Ryan, Mark, and Peter Serdyukov. (2007). “Writing effective lesson plans: The 5-star approach.
Boston: Allyn &Amp; Bacon.
17. Savage L. (1993). “Literacy through a competency-based education approach, Approaches to Adult
ESL Literacy Instruction”, Washington DC: Center for Applied Linguistics.
18. Voorhees P. (2002). Creating and implementing competency-based learning models. New Direc-
tions for Institutional Research, 110, 83–96.
19. Argüelles A, Gonczi A. (Eds.) (2000). “Competency based education and training: A world
perspective”, Mexico City: Grupo Noriega Editores.
Chapter 05.indd 108 5/28/2012 2:15:10 PM

20. Mrowicki L. (1986). “Project work English competency-based curriculum”, Portland, OR:
Northwest Educational Cooperative. p. 144—Approaches and Methods in Language Teaching.
21. Graden L., Zins J.E., Curtis M.J. (Eds.). “Alternative educational delivery systems: Enhancing
instructional options for all students”, Washington, DC: National Association of School
Psychologists. pp. 309–325.
Chapter 05.indd 109 5/18/2012 11:42:54 AM

c h a p t e r 6
Classroom Management
1. INTRODUCTION
Ms. Tara K, who is a lecturer in College of Nursing, was teaching research process to General Nursing
and Midwifery third-year students. Ms. Sandy, a student of this class, was sitting in the back row and
was laughing continuously without any reason (although she was not mad). The teacher noticed this
disrupted behavior and reminded her about this. For a while, Sandy becomes silent but after 2–3 min-
utes, she again started the same nonsense. The teacher warned her verbally and asked her to stand up
and keep standing until she permits her to sit down. After 10 minutes, the teacher thought that this
is enough penalties for Sandy’s disruptive behavior and she asked her to sit down. Surprisingly! The
student did not obey the command of her teacher, refused to sit down, and again started laughing. Ms.
Tara was shocked by this unexpected extreme form of indiscipline shown by Sandy. She rushed to the
principal’s office and informed to the principal immediately. Sandy was called to the principal’s office
and was suspended for a month.
Recently, a 9th class student in Chennai murdered his teacher in the classroom itself because he was not
satisfied with the marks he obtained in class test as well as with the comment the teacher made in his diary.
Once a teacher loses control of their classroom, it becomes increasingly more difficult for them
to regain that control
—Moskowitz & Hayman (1976)
As a teacher, you may also have faced such situation in your day-to-day teaching life. Sometimes,
it is very much difficult for you to handle the situation. Classroom management is possibly the most
difficult aspect of teaching for many teachers. Inability to manage the classroom effectively can force a
teacher to leave teaching profession forever. In 1981, the US National Educational Association reported
that 36% of teachers said they would probably not go into teaching if they had to decide again. A major
reason was “negative student attitudes and discipline.” Let us discuss what is classroom management
and the strategies to manage the classroom effectively.
Classroom management is essentially a teaching skill, which can be learned in the same way as other
teaching skills. The aim of teaching is to facilitate learning among students which is directly influenced by
how well a teacher manages his classroom. A well-managed classroom facilitates maximum utilization of
time in productive activities, and it ensures that all students are active participants in the learning process.
Classroom management refers to all the procedures, strategies, and practices used by the teacher
to keep the student disciplined and active as well as to ensure an environment in the classroom that is
conducive to learning for all students and allows maximum utilization of time in productive activities.
Chapter 06.indd 110 5/18/2012 11:43:18 AM

Classroom Management | 111
Ineffective teachers discipline their classrooms with consequences and punishments, whereas
effective teachers manage with procedures and routines
—Wong, H.K. (2006)
It is a well-established fact that each classroom is unique and each individual student is not same.
Hence it is not a child’s play to manage the classroom effectively because it is hard to accommodate the
needs of every child each day by using flexible group practices.
The very first day, the very first minute, the very first second of college, teachers should begin to
structure and organize their classrooms, to establish procedures and routines
—Wong H.K. (2004)
Berliner (1988) and Brophy & Good (1986) conducted research on classroom management and
concluded that the time that a teacher has to take to correct misbehavior caused by poor classroom
management skills leads to lower rate of academic engagement in the classroom.
2. PURPOSES OF CLASSROOM MANAGEMENT

❑❑ To ensure that classroom teaching run smoothly despite the disruptive behavior shown by some
students.
❑❑ To intimate the students what is expected from them.
❑❑ To maximize the time of academic learning.
❑❑ To prevent or minimize disruptive behavior shown by students.
❑❑ To provide an environment to the students this is conducive to learning.
❑❑ To exploit the maximum time for teaching learning activities.
3. PRINCIPLES OF CLASSROOM MANAGEMENT

According to Brophy (1983), there are three general principles for good classroom management:
❑❑ Willingness of the teacher to accept responsibility for classroom control.

❑❑ Long-term, solution-oriented approaches to problems rather than short-term, cease/control
responses.
❑❑ Check to see if symptomatic behavior is caused by underlying personal problems, e.g., impulsiv-
ity, lack of awareness, home problems, and sickness.
A variety of classroom management approaches can be used by the teacher to manage the classroom
effectively. The use of these approaches largely depends on the educational psychology in which the
teacher believes. Traditional classroom management involves behavior modification of the students for
which a teacher can use Pavlov’s classical conditioning approach or Skinner’s operant conditioning
approach. Another approach, which is relatively newer, is the holistic approach that uses affirmation
teaching to manage classroom. It motivates the students to be self-disciplined and to put their own
efforts toward their learning as well as managing classroom teaching learning environment.
Chapter 06.indd 111 5/18/2012 11:43:18 AM

Time management: Manage Academic excellence: Provide

your time effectively to highest possible excellent academic
maximize the academic time. instructions to the student.
Classroom
Management Discipline: Keep the students
Domains disciplined through tough love, firm,
and compassionate guidance
Be honest to your work: Be in

classroom, don’t try to make excuses to Develop IPR: Develop professional
dismiss the class unnecessarily, and relationship with the parents, students,
don’t cheat the students. colleagues, and administration.
Figure 6.1 Domains of Classroom Management
4. DOMAINS OF CLASSROOM MANAGEMENT

According to Eric Groves, there are five critical classroom management domains (Figure 6.1).
5. CLASSROOM MANAGEMENT STRATEGIES

5.1. Proactive Planning
Proactive planning is preventive in nature and involves in-depth preparation of interesting and challeng-
ing teaching learning activities to keep the students engaged in the teaching–learning process during a
class so that a successful and positive classroom climate can be maintained throughout the year.
5.2. Systematic Arrangement of the Classroom

A classroom that is highly congested is very difficult or sometimes impossible to manage. A well-man-
aged classroom should be systematically arranged, facilitating to and fro movement of the teacher so that
a teacher can move easily within the classroom to approach any student as well as every student can listen
to the teacher without any difficulty and watch the AV aids clearly used by teacher. Sitting plan should be
well organized in order that the teacher can keep a watch on all the students without any difficulty. Class-
room should be well lighted and ventilated; temperature should be under control and AV aids equipment
should be well fitted that will ensure the smooth running of the class throughout the academic year.
5.3. Communicate Expectations to the Students

At the commencement of the class, communicate your expectations to the students. For example, you
might say, “I expect you to maintain silence and raise your hands before you start answering the ques-
tion.” The students must be communicated about what you expect of them; once the students know in
advance about teacher’s expectations it will minimize the behavior problems of the students.
Chapter 06.indd 112 5/18/2012 11:43:18 AM

5.4. Use Preventive Strategies

It is very well said that “prevention is always better than cure.” It is easy to handle situation proactively
before it starts manifesting. Therefore, wise classroom managers identify the knock of disruptive be-
havior shown by students and mange it before it actually manifests. It will save your time and energy
and efforts to manage the classroom. Some of the preventive strategies include providing unconditional
support that is not based on the behavior of the students and using praise and reward for the students to
inform them about their behavior not to control it.
Common Classroom Problems

❑❑ Bunking the class
❑❑ Not paying attention
❑❑ Talking, gossiping during the lesson
❑❑ Laughing unnecessarily
❑❑ Sleeping in class
❑❑ Acting bored
❑❑ Coming unprepared
❑❑ Refusing to answer direct questions
❑❑ Looking outside the classroom
❑❑ Coming late, leaving early (when it disrupts others)
❑❑ Holding distracting conversations, disapproving groans
❑❑ Using cell phones or pagers during class
❑❑ Cheating, plagiarism
❑❑ Showing verbal and physical disrespect to the teacher
❑❑ Posing physical threats to the teacher
5.5. Time Management

Kauchak and Eggen (2008) in a book on teaching explained classroom management in terms of time
management. They divide class time into four overlapping categories, namely allocated time, instruc-
tional time, engaged time, and academic learning time.
Allocated time: It is the total time that is allotted to a teacher in the class schedule, for example, medi-
cal surgical nursing 10.00–11.00 AM (total time 1 hour). It refers to the time allotted for teaching–learn-
ing exercises as well as routine classroom activities such as attendance and announcements.
Instructional time: It is the time during which teaching and learning actually take place. If the time
taken for routine classroom activities is deducted from the allocated time, the resultant time will be
instructional time.
Instructional time = Total time – Time taken for routine classroom activities
Engaged time: During engaged time, students participate actively in learning activities, for example,
preparing for role play, asking and responding to questions. It refers to the time during which students
are actively engaged in learning activities.
Chapter 06.indd 113 5/18/2012 11:43:18 AM

Academic learning time: It is the time when students participate actively and are successful in
learning activities. Effective classroom management is aimed to maximize academic learning time.
5.6. Overplanned Lesson

Free time available in a classroom is an important factor responsible for majority of the disruptive be-
havior shown by the students as well as it shows that as a teacher you are not interested in academics.
The problem of free time arises when the teacher has not planned adequate content to teach in the allot-
ted time frame. The strategies to overcome this problem are overplanning of classroom activities and
writing additional learning activities in the lesson plan so that in case your main lesson runs short you
can avoid free time in your classroom.
5.7. Avoid Leniency

It is very well said “Never smile until Christmas.” If you are a lenient or an easy-going teacher who
manages the students with poor discipline plan as well as allows them for classroom disruptions during
the commencement of the academic session, then it will be very difficult for you to manage the class-
room throughout the year. Therefore, be very strict from the beginning of the session so that students
see that you are willing to do whatever is required to control classroom.
5.8. Fair Treatment

Treating fairly all the students will increase the respect of teacher among the students. If students are not
treated equally and fairly, then the students will not be keen to follow the rules. Therefore, if topmost
students make mistakes they should be punished for it accordingly.
5.9. Dealing Disruptions with Little Interruption

Whenever you observe any disruptive activity in the classroom immediately deal with it however; at-
tempt to make as little interruption as possible to the teaching–learning activities. For example, you
observed that two students are gossiping in the running class; to handle this situation you may ask one
of them a question related to the current topic that will get them back on the track with little or no dis-
traction to the entire class. It is not fair (until it is a compulsory) to stop the flow of your lesson to deal
with disruptions; by doing so, you are cheating those students who really want to learn by wasting their
precious time. Since many disruptions occur during transitional times in classroom, it is better to have
your notes or papers ready to go or your assignment already written on the board.
5.10. Use Humor

A teacher should have a good sense of humor because sometimes it may be useful to get things back on
the track in a classroom. For example, you observed that a student was taking a nap during the class;
in order to handle this situation you shouldn’t shout at the student, instead of that just keep staring at
him/her. It will catch the attention of whole class and will probably get a few laughs and the neighbors
will awake that student. Rarely, you can present a joke/laughter to the class if most of the students feel
bored or become inattentive due to abstract or boring topic; however, be careful it is not a good idea to
use jokes routinely in the classroom.
Chapter 06.indd 114 5/18/2012 11:43:18 AM

5.11. Avoidance of Confrontation

It is a well-established rule of the discipline that it should be administered privately so that the student
will not feel of “losing face” in front of the friends, and in future there are more chances that he/she will
show more compliance with the classroom rules.
5.12. Consistencies in Dealing with Students

Rules and regulations are effective only when reinforced consistently. For example, if misbehaviors of
the students are ignored today and the next day they are penalized for a small mistake, then students will
not perceive you as consistent administrator of discipline and their behavior will not be modified. You
will lose respect among students, and classroom disruptions will probably increase.
5.13. Simple and Understandable Classroom Rules

Classroom rules should be simple and easily understandable. A teacher needs to be selective while
preparing classroom rules. He/She should identify three to five classroom rules that are important for
classroom management. Rules should clearly communicate what is acceptable and not acceptable be-
havior in the classroom. The consequences of breaking the rules should also be clearly communicated
to the students (Table 6.1).
5.14. Use Sarcasm Cautiously

Sarcasm is speech or writing that actually means the opposite of what it seems to mean. It is usually
intended to mock or insult someone. It should not be used routinely in the classroom because many
students do not have the capacity to know that sarcasm is not meant to be taken literally. Some students
can perceive it as seditious, which would compromise the purpose of good classroom management.
5.15. Consistent Discipline Administration

Keeping the students disciplined in the classroom is the ultimate aim of all classroom management
activities. A kind-hearted teacher usually tries to avoid administration of discipline, but he/she must
understand that discipline is crucial to manage classroom effectively. American counselor Phyllis York
mentioned in her writings about heartbreaking cases of defiant youngsters who were prosecuted in
TABLE 6.1 Levels of Reward and Penalty for Discipline

Level of importance Reward Penalty
Level 1 Smile Eye contact

Compliment Change seats
Positive note on assignment Negative note on assignment
Level 2 Displaying good work on classroom Loss of privileges
bulletin board Call to parents
Appreciation letter to parents
Allow special privileges
Level 3 Recognition at awards ceremony Trip to principal’s office
Publish in local newspaper or TV channel Loss of special class event (e.g., picnic)
Chapter 06.indd 115 5/18/2012 11:43:18 AM

juvenile court because of the reluctance of their parents and teachers to impose discipline. Therefore,
discipline in the form of “tough love” should consistently point out students’ disruptive behavior when
it interferes with the order of the classroom.
Steps for Better Classroom Discipline

Step 1: Reminder
The teacher should remind to the students about the infringement of rules early enough so that the
situation does not progress beyond a limit where a simple reminder becomes ineffective. It should be
directed to the whole class at once or to the students concerned.
Example: Ms. Raman and Tanwi, the rest of us have all started group discussion, you need to stop
talking and focus on it.
Step 2: Warning
Despite the reminder, if the student continues to disturb the class, in that case the teacher should ap-
proach the student for either verbal or written warning. While delivering verbal warning, the teacher
should move close to the student and let him/her know what he/she is expected to do, at the same time
ask the student about the next step. Similarly, while administering written warning, the student is ap-
proached and handed over a warning slip. He is notified that if no further problem occurs he/she will be
able to throw the slip away after the class is over. If the misbehavior continues, the warning slip will be
collected and communicated to the principal’s office.
Example: Despite the reminder, Aman was continuously teasing Reema. The teacher fills out a
violation slip and approaches Aman “Here is a violation slip with your name on it; I’m putting it
here on the corner of your table. If it is still there when the class finishes, you may throw it away.
If you continue to tease her, I will pick it up and will send to the principal office.”
Step 3: Violation Slip

If Aman has received a written warning beforehand and continues to show disruptive behavior, the slip
is collected from her and submitted to the principal office. The student is asked to identify the next step.
Step 4: Trip to principal office
The student is removed from the class and is sent to the principal office for further disciplinary proceedings.
6. BEHAVIOR MODIFICATION STRATEGIES

6.1. Classical Conditioning Approach
Great psychologist Pavlov developed the classical conditioning theory for behavior modification. By
using classical conditioning, teachers have the ability to:
❑❑ Affect student’s likes/dislikes
❑❑ Influence student’s attitudes toward learning
❑❑ Develop a respect for authority
Chapter 06.indd 116 5/18/2012 11:43:18 AM

Affecting Students Likes/Dislikes

Classical conditioning theory indicates that people develop an inclination for pleasant experiences and
decline to experiences they find unpleasant.
Influencing Students’ Attitudes Toward Learning

Classical conditioning theory suggests that students will develop positive attitude toward learning, pro-
vided that they receive comments that evoke positive feelings such as “excellent,” “well done,” and so on.
Develop a Respect of Authority
Classical conditioning theory explains that students develop respect/fear based on conditioned stimuli
that are associated with unpleasant unconditioned stimuli. This theory also suggests that people do not
have to experience the unpleasant stimuli firsthand but will develop respect/fear of conditioned stimuli
by watching someone’s experience with unpleasant unconditioned stimuli.
6.2. Operant Conditioning

Operant conditioning theory of behavior modification was proposed by B.F. Skinner. The theory sug-
gests that a response that is immediately followed by a reinforcer is strengthened and is therefore more
likely to occur again.
Important Criteria for Operant Conditioning
❑❑ The reinforcer must follow the response.
❑❑ The reinforcer must follow immediately.
❑❑ The reinforcer must be contingent on the response.
❑❑ Positive reinforcement involves the presentation of a stimulus after a response such as a smile,
positive words, and a good grade.
❑❑ Punishment is not synonyms with negative reinforcement.
❑❑ Negative reinforcement increases the frequency of a response by taking away a negative stimulus.
❑❑ Punishment decreases the frequency of a response by giving a negative stimulus or taking away
a positive stimulus.
7. COMMON MISTAKES IN CLASSROOM MANAGEMENT

❑❑ Defining the problem behavior by how it looks without considering the root cause of it
❑❑ Applying the same approach for every student
❑❑ Rigidly following the rules and procedures
❑❑ Inconsistency in expectations and consequences
❑❑ Disrespectful teacher’s behavior
❑❑ Changing assignments or test dates without warning
❑❑ Vulgarity
❑❑ Harassing comments and actions, threats of harm to career
❑❑ Arriving late for class, leaving early
❑❑ Poor lecture/teaching skills
❑❑ Refusing to answer questions posed by students
❑❑ Deviating from the course syllabus
Chapter 06.indd 117 5/18/2012 11:43:18 AM

Solution to Some Serious Common Classroom Problems

THE ANGRY STUDENT
❑❑ Open the door or move into the hall
❑❑ Know his/her name
❑❑ Reflect back his/her feeling
❑❑ Buy time (the 24-hour rule)
❑❑ Respond later
❑❑ Document the interaction
STUDENT BECOMES VERBALLY CONFRONTATIONAL

❑❑ Remain calm.
❑❑ Do not shout.
❑❑ Do not bring the rest of the class into the situation by involving them in the discipline or the
writing of the referral.
❑❑ There will always be a winner and a loser, which sets up a power struggle that could con-
tinue throughout the year.
STUDENT BECOMES PHYSICAL

❑❑ Remain as calm as possible; it can sometimes diffuse the situation.
❑❑ Use the call button for assistance if available.
❑❑ Send a student to get help from another teacher.
❑❑ Dismiss the class and send the other students from the room if they could get hurt.
❑❑ “Buy time,” let the student realize that he has made serious mistake.
❑❑ If the fight is between two students, follow your school’s rules concerning teacher involve-
ment as many want teachers to stay out of fights until help arrives.
❑❑ Keep an anecdotal record of major issues that arise in your class.
❑❑ Classroom management and disruption issues should be left in class so that you can have
some downtime to recharge before coming back to another day of teaching.
Chapter 06.indd 118 5/18/2012 11:43:18 AM

CHAPTER HIGHLIGHTS
❑❑ Classroom management is essentially a teaching skill that can be learned in the same way as other
teaching skills.
❑❑ Classroom management refers to all the procedures, strategies, and practices used by the teacher
to keep the student disciplined and active as well as to ensure an environment in the classroom
which is conducive to learning for all students and allows maximum utilization of time in produc-
tive activities.
❑❑ According to Brophy (1983), there are three general principles for good classroom management:
Willingness of the teacher to accept responsibility for classroom control, long-term, solution-
oriented approaches to problems rather than short-term, cease/control responses, check to see
if symptomatic behavior is caused by underlying personal problems (e.g., impulsivity, lack of
awareness, home problems, and sickness).
❑❑ Proactive planning, organized physical set-up of classroom, keep high expectations and com-
municate the same to the students, manage classroom time effectively, overplanned lesson, don’t
be a “lenient” teacher, treating students fairly, dealing disruptions with little interruption, use of
humor, avoiding confrontation in classroom, consistently dealing with students, make classroom
rules simple and understandable, use sarcasm sparingly, and maintain discipline consistently are
some of the important classroom management strategies.
❑❑ Classical conditioning and operant conditioning are two great theories of behavior modification
that can be applied for classroom management.
❑❑ Applying the same approach for every student, rigidly following the rules and procedures, incon-
sistency in expectations, and consequences and disrespectful teacher’s behavior are some of the
common mistakes in classroom management.
❑❑ The inattentive student, the angry student, and the student becomes verbally confrontational and
physical are some of the serious classroom problems that teachers encounter in their day-to-day
classroom teachings.
EVALUATE YOURSELF
Q 1: Explain briefly about ideal classroom environment (RGUHS, 2010).
Q 2: What is discipline, explain preventive discipline to manage classroom (MGU, 2009)?
Q 3: Explain disciplines of students in school of nursing (MGRUHS, 2010).
Q 4: Write a short note on time management as an effective classroom management strategy.
Q 5: How will you modify the behavior of your students?
1. Brophy J. (1983). Effective classroom management. The School Administrator, 40(7), 33–36.
2. Charles H. Wolfgang, Carl D. (1986). “Solving Discipline Problems”, Allyn and Bacon.
3. Moskowitz G., Hayman J.L. (1976). Success strategies of inner-city teachers: A year-long study.
Journal of Educational Research, 69, 283–289.
Chapter 06.indd 119 5/18/2012 11:43:18 AM

4. Berliner D.C. Effective classroom management and instruction: A knowledge base for consultation.
In: Graden J.L., Zins J.E., Curtis M.J. (Eds.). “Alternative educational delivery systems: Enhanc-
ing instructional options for all students”, Washington, DC: National Association of School Psy-
chologists. pp. 309–325.
5. Allen J.D. (1986). Classroom management: students’ perspectives, goals, and strategies. American
Educational Research Journal, 23, 437–459.
6. Marilyn E. Gootman. (2008). The caring teacher’s guide to discipline: helping students learn self-
control, responsibility, and respect, K-6,36.
7. Pintrich P.R., De Groot E.V. (1990). Motivational and self-regulated learning components of class-
room academic performance. Journal of Educational Psychology, 82, 33–40.
8. Bear G.G., Cavalier A. Manning M. (2005). “Developing self-discipline and preventing and cor-
recting misbehavior”, Boston: Allyn & Bacon.
9. Dr. Marvin Marshall. (2001). “Discipline without stress, punishments or rewards”, Los Alamitos:
Piper Press. ISBN 0-9700606-1-0.
10. Barbetta P., Norona K., Bicard D. (2005). Classroom behavior management: A dozen common
mistakes and what to do instead. Preventing School Failures, 49(3), 11–19.
11. Harry K. Wong, Rosemary T. (1998). “The first days of school”, Mountain View: Harry K. Wong
Publications.
Chapter 06.indd 120 5/18/2012 11:43:18 AM

c h a p t e r 7
Instructional Strategies
1. INTRODUCTION
Instructional strategies are the techniques of teaching used by a teacher either in isolation or in combina-
tion to facilitate learning by the students. Each teaching strategy is suitable for a particular lesson or seg-
ment of the lesson. During the planning phase of teaching (lesson planning), the teacher should decide
about the strategy that will be most suitable for the particular lesson to be taught. The teacher needs to
employ mix-mode strategies as per the requirement of the lesson, size of the group and the availability
of resources. For example, a teacher is assigned to teach “Methods of oxygen administration” to B. Sc
Nursing III year students. Is discussion the appropriate method for this topic? Of course not, to teach
“Methods of oxygen administration” the teacher has to use the lecture method mixed with demonstra-
tion of each oxygen administration method or sometimes augment the teaching by video clippings if
resources permit. In this chapter we will discuss some of the important instructional strategies used by
nursing teachers in a classroom teaching–learning environment.
2. LECTURE METHOD
Lecture method is one of the commonest and oldest methods of teaching. It has been used extensively
by nursing faculty to teach almost all the subjects of the nursing curriculum at all levels of nursing edu-
cation, whether it is ANM, GNM, B. Sc (N) or M. Sc Nursing course.
The lecture method is a method of teaching in which the teacher delivers the content by verbal communi-
cation in front of the students and the students listen carefully to the teacher. The teacher transmits informa-
tion, knowledge, facts and data by talking to the students and the students take notes, clarify doubts and listen
to the talk of the teacher. Sometimes, to make the learning easy and to explain a complex part, the teacher
may augment the lecture by a short group discussion or by using blackboard, etc. The underlying assumption
of the lecture method is that knowledge is an object that can be transferred from the teacher to the learner.
2.1. Definition
Lecture can be defined as a method of teaching in which a teacher delivers or presents preplanned topics
of interest through verbal communication or by talking to the students in order to achieve pre-specified
teaching–learning objectives.
2.2. Pros of the Lecture Method

❑❑ The teacher can effectively manage the teaching–learning environment in the classroom because
the teacher can keep an eye on the students during the lecture session.
Chapter 07.indd 121 5/18/2012 11:44:32 AM

❑❑ The lecture method is a low-cost method of teaching because it consumes little resources of the
organization. Therefore, it reduces the cost of teaching.
❑❑ It provides flexibility to the teacher; they can alter their lecture any time according to the needs,
interests of the students and available time.
❑❑ It helps in maintaining motivation and interest of both the teacher and the students in the classroom.
The teacher can be motivated by the positive responses from the students on questioning and the stu-
dents can be kept motivated through the use of humor, nonverbal communication, gestures and posture.
❑❑ Presents factual material in direct, logical manner.
❑❑ Stimulates thinking to open discussion.
❑❑ Useful method of teaching large groups of students.
2.3. Cons of the Lecture Method

❑❑ Students’ role in the lecture method is as passive learners that results in passive learning which
cannot be considered an effective learning strategy.
❑❑ The lecture method requires excellent communication skills in which all the teachers may not be
perfect.
❑❑ Scope of participation of the learners is limited.
❑❑ Sometimes a lecture becomes a one-sided show (communication in one way) which is of no use
to the students.
❑❑ If the size of the class is bigger then the teacher loses control over the class that may jeopardize
the teaching–learning environment.
❑❑ It may not be suitable for some teaching–learning situation, e.g., teaching oropharyngeal suction-
ing skills to nursing students.
❑❑ Students may get bored and become inattentive if the teacher’s voice is monotonous or if he or
she is unable to create interest and motivation among students and/or does not ask questions in
between the lecture.
❑❑ It is difficult to gauge the learning while using lecture as a teaching method.
2.4. Guidelines to Improve the Lecture Method

❑❑ Prepare the lecture in advance: the contents of the lecture must be prepared in advance. It pro-
vides an opportunity to the teacher to select and organize the content in sequence and simplify the
complex concepts to the level of understanding of the students. Advance planning also permits
effective use of questioning (which questions to ask, where to ask and to whom to ask) as well as
decide where to take pauses, about use of gestures and postures etc.
❑❑ Select supplementary strategies to make a lecture interesting and stimulating (AV aids, black-
board, demonstration, power point slides etc.).
❑❑ Acquire mastery over the selected contents and practice the lecture beforehand.
❑❑ Keep in the mind the level of understanding of the students, interest of the students and the impor-
tance of the topic while preparing the outline of the lecture.
❑❑ Introduce the lecture in an interesting way by asking questions or by telling a story relevant to
the topic or by giving a problem scenario to the students. It will keep the students alert and will
develop interest in the topic.
❑❑ Dress in a pleasant and soothing way as it will appeal to students.
Chapter 07.indd 122 5/18/2012 11:44:32 AM

Instructional Strategies | 123
❑❑ The teacher should never turn their back to the students even while writing on blackboard or
showing charts and any other media.
❑❑ Use effective communication skills (verbal and nonverbal). A good use of humor is necessary to
keep the students interested.
❑❑ Encourage the students to participate actively by encouraging them to ask questions and clarify doubts.
❑❑ Voice should be modulated as per the requirement of the particular content area.
❑❑ Maintain eye contact with the students. It helps to maintain discipline in the classroom and keeps
the students alert.
❑❑ Be on track by not wasting time on irrelevant facts, unnecessary detailed explanations.
❑❑ Plan to explain difficult portions of the lecture by quoting suitable examples.
❑❑ Plan to ask questions at frequent intervals to create and sustain interest.
❑❑ The teacher need not be too sensitive to whispered conversations and restlessness showed by the
students. They should not be taken as pointers to change the strategy of presentation.
❑❑ Summarize the key points in between and at the end of the lecture.
Research study conducted by Mahler SA et al (2011) on techniques for teaching electrocardiogram
interpretation reported that the lecture method resulted in better learning as compared to self-directed
learning. In another study by Beers GW (2005), it was reported that the lecture method was comparable
to problem-based learning to teach diabetes to nursing students.
Broken Lecture: An Innovation

This innovation in lecture method was developed by Satheesha B. Nayak Melaka, Manipal Medi-
cal College (Manipal Campus). In this innovative lecture technique a one-hour traditional lecture
is broken down in to three segments of 15 minutes each. The remaining 15 minutes are further
broken down in to three parts of 5 minutes each, which follows the 15-minute segment of the
lecture. During those 5 minutes, the teacher remains silent and the students are asked to answer
questions which are put on power-point slides, the questions are related to the next upcoming
15-minute session. The students are allowed to discuss with peers and refer to the text book to find
answers to the questions. It encourages active learning among the students, breaks the monotony
of the lecture and creates interest among students.
3. DISCUSSION
Discussion is consideration of a question or problem in open and usually informal debate in which every stu-
dent is encouraged to put his views on the topic under consideration. Sometimes, it may be a formal treatment
of a topic in speech or writing. Discussion is a useful teaching strategy when the size of the group is small.
3.1. Execution of Group Discussion

❑❑ Topic for discussion is selected beforehand and students are asked to come prepared. Sometimes
topics may be selected on the spot.
❑❑ The teacher may assume the role of chairperson/moderator or sometimes may assign this role to
a student. The teacher or chairperson must be familiar with group dynamics to make the group
discussion effective and should not be biased with the topic of discussion.
Chapter 07.indd 123 5/18/2012 11:44:32 AM

❑❑ Roles of recorder and observers are assigned to students.

❑❑ The group sits in front of the class if all the students are not involved in the group discussion.
Sometimes the group may sit around a table if class size is small and all the students participating
in the group discussion.
❑❑ The chairperson opens the discussion by introducing the topic to be discussed, the purpose of the
discussion and the introduction of the group members.
❑❑ The group members discuss the topic, share their views and experiences in an informal manner in
order to solve the problem or to reach a consensus.
❑❑ The chairperson has to apply strategies for effective group dynamics. They have to control the
dominant group member otherwise the group discussion may become one sided and at the same
time they have to encourage those members who are shy. The chairperson has to ensure that the
group keeps on track.
❑❑ The recorder records the main points which emerge from the discussion.
❑❑ The group continues the discussion until a consensus is reached.
❑❑ The recorder communicates the main points which are discussed by the group at the end of the
discussion.
❑❑ The chairperson summarizes and concludes at the end of the discussion.
3.2. Pros of the Discussion Method

❑❑ A wide variety of ideas and experiences are generated from group discussions to solve the problem.
❑❑ It is an effective method of active learning after a presentation or an experience that needs to be
analyzed. For example, after a community visit to a sewage plant, the group discussion may be
conducted in the classroom.
❑❑ It allows every student to participate actively.
3.3. Cons of the Discussion Method

❑❑ It is not practical to conduct discussions whenever there are 20 or more students.
❑❑ Sometimes a few people can dominate the discussion if the moderator is not encouraging the shy
group members to speak.
❑❑ It is a time-consuming activity.
❑❑ Sometimes there are chances that the discussion can get off the track.
❑❑ It requires careful planning by the moderator/facilitator to guide the discussion.
4. SMALL GROUP DISCUSSION

It is a discussion carried out in small groups. The size of the group is small which is easily manageable
and consensus can be achieved easily.
4.1. Pros of Small Group Discussion

❑❑ It allows the participation of every student since the size of the group is small.
❑❑ Students are more comfortable in small groups than in large ones.
❑❑ Group consensus can be reached easily.
Chapter 07.indd 124 5/18/2012 11:44:32 AM

4.2. Cons of Small Group Discussion

❑❑ If not controlled by the moderator, the group may go off track.
❑❑ Specific tasks or questions need to be prepared for the group to answer.
5. DEMONSTRATION
Demonstration is a teaching method frequently used to teach psychomotor skills to nursing students. In
this method, the teacher exhibits the procedure by explaining every step of the procedure in sequence in
front of the group of students, either in a lab or in a real-life setting. The students are then asked to per-
form a return demonstration. Sometimes, return demonstrations may not be necessary when the group
is very large or the time required to perform the return demonstration is high.
Sometimes, a lecture or informal talk may precede the demonstration to prepare a background for the
same. Since Nursing is a practice-oriented profession, this particular method is quite important to teach
psychomotor skills to the nursing students. It is advisable for nurse teachers that every procedure must
be taught in the classroom followed by practice in the laboratory; then, the students can be allowed to
perform it in a clinical setting.
5.1. Definition
Demonstration as a teaching method is the exhibition of a procedure with the explanation of every step
by the teacher in front of the students either in a laboratory or in a real-life setting to develop or teach
psychomotor skills.
The demonstration step gives trainees the opportunity to see and hear the details related to the skill
being taught. Those details include the necessary background knowledge, the steps or procedure, the
nomenclature and the safety precautions.
5.2. Pros of the Demonstration Method

❑❑ Demonstration activates several senses of the learner simultaneously which leads to better learning.
❑❑ It inculcates observation skills among student nurses, which is an essential requirement to be a
good nurse.
❑❑ It correlates theory with practice.
❑❑ It stimulates interest among students by use of concrete illustration of sequence of the procedure.
❑❑ Return demonstration by the students under the supervision of the teacher provides the opportu-
nity to practice the particular skill before applying it in a clinical setting.
5.3. Cons of Demonstration

❑❑ Not suitable if the group is very large.
❑❑ Requires resources to conduct demonstrations.
5.4. Steps of Demonstration

Before demonstration, the teacher may prepare in the following manner.
❑❑ Formulate the general and specific objectives of the demonstration.
❑❑ Perform a thorough analysis of the skill and determine the sequence of activities to be carried out.
(if the procedure’s sequence is already standardized than follow it)
Chapter 07.indd 125 5/18/2012 11:44:32 AM

❑❑ Identify and assembles the articles required for demonstration.

❑❑ Ensure that all the articles are in working order.
❑❑ Formulate the lesson plan for the demonstration.
❑❑ Make every effort to get students to observe correct procedures the first time they try a new task.
During the demonstration
❑❑ Introduce the learners to the objectives of the demonstration.
❑❑ Motivate the students by explaining the importance of the particular skill.
❑❑ Ensure that every student is having a good view of the demonstration.
❑❑ Arrange the articles in order of use and explain the articles to be used in the demonstration.
❑❑ Demonstrate the entire procedure at a normal pace.
❑❑ If the procedure is long and complex, break it into parts.
❑❑ Always use a positive approach (students should be taught first about what to do than what not to do).
❑❑ Explain each step meticulously and slowly in sequence (name the articles used in each step, and
explain how to perform that step).
❑❑ Obtain feedback from the students after each step by questioning and by observing the nonverbal
behavior of the students.
❑❑ Re-emphasize the vital and important steps at the end of the demonstration.
❑❑ Explain how to record the procedure in nurses’ record with time and date.
❑❑ Conclude and summarize.
After the demonstration
❑❑ Students should be asked to perform a return demonstration so that they will master the skill be-
fore applying it in a clinical situation. The most effective learning takes place when students use
a skill immediately after they have learnt it. Therefore, as soon as the teacher teaches the students
to do a job, have them practice the skill.
❑❑ Individualize the return demonstration to satisfy the students’ needs.
❑❑ Clarify the doubts, invite questions and answer queries at the end of the demonstration.
❑❑ Replace the articles.
6. LECTURE-CUM-DEMONSTRATION METHOD
It is a combined teaching strategy in which a lecture is accompanied by a demonstration of the skill. This
method of teaching includes the merits of both the lecture and demonstration methods. The teacher per-
forms the skill demonstration in the class and goes on explaining (just like running commentary) what they
do. It takes into account the active participation of the students and is thus not a one-sided show like the
lecture method. The students see the actual equipments and live steps of the procedure, thereby feeling in-
terested in learning. It provides the students with the knowledge as well skills of the particular nursing care
procedure. Students observe the demonstration critically and try to draw inferences. Thus, with the help
of the lecture-cum-demonstration method, their powers of observation and reasoning are also exercised.
6.1. Pros of the Lecture-Cum-Demonstration Method

❑❑ It is an economical method of teaching, especially useful for resource-limited settings.
❑❑ Students take active interest in the teaching–learning process.
Chapter 07.indd 126 5/18/2012 11:44:32 AM

❑❑ It leads the students from concrete to abstract situations.

❑❑ It is a suitable method if the apparatus to be handled is costly and sensitive. Such apparatus is
likely to be damaged by the students.
❑❑ This method is safe if the experiment is dangerous.
❑❑ It can be successfully used for all types of students.
❑❑ It improves the observational and reasoning skills of the students.
6.2. Cons of the Lecture-Cum-Demonstration Method

❑❑ It provides no scope for “learning by doing” for the students as they are only observing the teacher
performing.
❑❑ Since the teacher performs the experiment at his/her own pace many students may not be able to
comprehend the concept being clarified.
❑❑ It is not a student-centric method as it makes no provision to cater to individual differences among
learners. All types of students including slow learners and geniuses have to proceed at the same
speed.
❑❑ It fails to develop laboratory skills in the students.
❑❑ In this method, students may fail to observe many finer details of the apparatus used because they
observe it from a distance.
7. SIMULATION
It is an entirely different teaching strategy as compared to the traditional teaching methods. Traditional
teaching methods emphasize on linear thinking, where a single concept is taught at a time. This type
of learning cannot be useful when a nurse is working in a clinical setting where he/she has to make
decisions about patient care priorities which require integrative type of thinking. For example, a novice
critical care nurse learns about atrial fibrillation, ventricular tachycardia, heart block, stroke and renal
failure in separate lectures. Therefore, he/she may face difficulty in understanding why overdrive pac-
ing is used to treat atrial fibrillation and how atrial fibrillation can cause stroke and renal failure. Under-
standing the nursing care priorities for such a patient requires an integrative or circular type of thinking
about physiology, pathophysiology and treatment because these priorities are interrelated.
Simulation is a useful teaching strategy for illustrating a complex and changing situation. It is the imita-
tion of a real thing, state of affairs, or process. It is an event or situation made to resemble clinical practice
as closely as possible. It allows learners to function in an environment that is as close as possible to an
actual clinical situation and provides them with an opportunity to “think on their feet, not in their seat.” In a
simulation, the learner acts, the simulator reacts and the learner learns from this feedback. The emphasis is
often on the application and integration of knowledge, skills and critical thinking. Research has shed some
light on usefulness, authenticity and efficacy of the simulation method in terms of knowledge gain, retention
of learning and students’ interest. It is the best method of teaching used in nursing to teach concepts, allow
risk-free practice as well as to teach, practice and evaluate critical-thinking skills among nursing students.
The most recent technology incorporates computer-based simulators that support CD-ROM applica-
tions which allow the learners to progress through a clinical situation by responding to questions and
selecting therapies. These applications require learners to analyze the data and make a response. Inter-
active computerized cardiopulmonary resuscitation or advanced cardiac life support simulators allow
learners to practice psychomotor skills and receive feedback on the performance.
Chapter 07.indd 127 5/18/2012 11:44:32 AM

7.1. Types of Simulation

Some common types of simulation are as following.
7.1.1. Physical Simulation

Physical Simulation refers to simulation in which physical objects are substituted for the real thing. These
physical objects are often chosen because they are smaller or cheaper than the actual object or system.
7.1.2. Interactive Simulation

Interactive simulation is a special kind of physical simulation in which physical simulations include
human operators, such as in a flight simulator or a driving simulator. It can use a computer to create a
synthetic environment for simulation.
7.1.3. Training Simulation

Training simulations may be further categorized into three categories:
❑❑ Live simulation: it is one in which real people (healthcare provider) use simulated equipment or
mannequins in real-world settings.
❑❑ Virtual simulation: in virtual simulation real people use simulated equipment in a simulated world,
or virtual environment). The difference between live and virtual simulation is of settings in which
they are performed.
❑❑ Constructive simulation: in constructive simulation, simulated people use simulated equipment in
a simulated environment. Constructive simulation is often referred to as “game simulation” since
it bears some resemblance to table-top war games in which players command armies of soldiers
and equipment that move around a board.
7.1.4. Pros of Simulation

❑❑ Simulation is a more realistic method of teaching which enhances both acquisition and retention
of knowledge.
❑❑ It sharpens critical thinking and psychomotor skills among nursing students and is more enjoyable
than traditional methods of teaching.
❑❑ Learning in adults is most effective when the environment is both participative and interactive as
it is present in simulation.
❑❑ It provides immediate feedback of the performance that is more motivating for the learners.
❑❑ Teaching methods that require a learner to think through data or information and come to a con-
clusion or predict an outcome are more effective than through reading or from a lecture.
❑❑ The minute-to-minute care and monitoring of critically ill patients requires nurses to collect, analyze,
and react to data and information. Simulation is an excellent way to both teach and practice these skills.
❑❑ Simulation is a method of teaching that allows or requires learners to apply theory to practice in an
integrated manner. If the simulation demonstrates more than a single event or parameter at a time,
nurses learn to identify relationships essential and common to clinical practice.
❑❑ Simulations are highly motivating, both intrinsically and extrinsically.
❑❑ Simulation often goes hand-in-hand with visualization.
Rogers et al studied fourth-year medical students during their rotations in critical care. The students
were evaluated before and after the rotations by using a multiple-choice written examination, a skill
Chapter 07.indd 128 5/18/2012 11:44:32 AM

station test, and an interactive simulation with a high-fidelity simulator. Although the test results before
the rotations were similar for all three types of evaluations, the results after the rotations differed. The
students performed much better on the written examination than on the simulation tests after the rota-
tions, showing that although theory could be applied in a written case study, application of theory was
not as easily demonstrated in a clinical simulation.
Steps of Simulation
1. Introduction
❑❑ Students are introduced to the topic of the simulation and its learning objectives. They are
presented with some common clinical scenarios to stimulate thinking among students about
real life complex situations.
❑❑ Roles are assigned to the students as per the requirement of the simulation.
2. The Simulation
❑❑ The students participate in the simulation, playing their roles as assigned. The role of the
teacher is to act as a coach and they should try to stay uninvolved in the simulation, except
when they notice that they can facilitate the educational opportunities that the simulation
presents at a particular moment.
❑❑ While the students are performing, they could make anecdotal records, or complete checklists.
3. Debrief
❑❑ During the debrief session, students are divided in small groups for discussion.
❑❑ There should be one common question about how the students think the simulation is like
the real thing and how it is not like the real thing. Give each group of students one question
to discuss.
❑❑ Five minutes before the time is up visit each group. Choose a speaker and write a summary
of the discussion for the speaker to present to the class or the students are asked to write the
answers to the questions in a learning log instead of having them present to the class.
7.1.5. Cons of Simulation

❑❑ Cost may be one issue since simulation requires the use of simulators which are costly but the
advantage of practice without risk to patient outweighs the disadvantage of the simulator’s cost.
❑❑ Requires a lot of time and energy for preparation.
Gordon et al surveyed both students and educators about simulation as a teaching tool. Both groups
thought that the advantage of “practice without risk to patient” outweighed the disadvantage of the
simulator’s cost.
8. SEMINAR
The word seminar is derived from the Latin word “seminarium” which means “seed plot”. Seminar as
a teaching method has the function of bringing together small groups for recurring meetings, focusing
each time on some particular subject in which everyone present is requested to actively participate.
Chapter 07.indd 129 5/18/2012 11:44:32 AM

A seminar is a presentation on a topic covering some facet of knowledge or skill. The speaker’s goal
is to impart knowledge of the topic, and he or she typically uses a combination of lecture, visual aids,
interaction with participants and exercises to get the job done. Due to the emphasis on theory and the
imparting of information, a seminar is typically of no more than three hours duration.
Participants of a seminar must not be beginners in the field under discussion (at US universities,
seminar classes are generally reserved for upper-class students, although at UK and Australian univer-
sities, seminars are often used for all years). The purpose behind the seminar system is to familiarize
students more extensively with the chosen topic and also to allow them to interact with examples of the
practical problems that frequently occur during clinical/research work. It is essentially a place where
an assigned topic is discussed, questions can be raised and debates can be conducted. It is relatively
informal as compared to the lecture system of academic instruction.
Sometimes, a seminar may be a large lecture course, when it is conducted by a prominent thinker
(regardless of the size of the audience or the scope of student participation in discussion).
8.1. Pros of the Seminar Method

❑❑ Provides scope for group discussion that result in active learning.
❑❑ It helps students to critically analyze the topic under consideration.
❑❑ It has the capability to provoke better discussion than a one-person discussion.
8.2. Cons of the Seminar Method

❑❑ Students presenting the seminar may not be good speakers to speak on the topic of interest.
❑❑ It is a resource- and time-consuming activity.
❑❑ Students require good background knowledge of the topic under consideration.
9. PANEL DISCUSSION
Panel, in the context of teaching methods is referred to a group of experts (usually 5–7 in number) or
professionals who are proficient in the field of their specialty or who have some special knowledge of
the chosen topic for panel discussion.
9.1. Definition
A panel discussion is a type of discussion in which a group of panel members get together and discuss
about a given topic. All the group members put out their opinions regarding the issue/problem under
discussion; therefore, many ideas are generated, discussed and then a conclusion is made.
The purpose of panel discussion is to solve a particular issue or problem, which seem difficult to be
solved by one person. If an issue is too complex for one person to handle, a panel may be gathered so
a group of specialists can speak on that issue. Sometimes, it may be conducted when the students need
exposure to various people or viewpoints at the same session.
Technically, a panel discussion consists of questions and answers only; it is not like lecturing on one
topic. The moderator has to monitor time and manage questions. If each participant is making a speech
for a set period of time, he should signal the speakers at the one-minute-to-go mark and at the stop mark.
If a speaker goes more than one or two minutes, he can stop them to give equal rights to each speaker.
The moderator must be an unbiased person; they should be neither for nor against the topic. At the end
they should summarize the discussion and thank the panel members.
Chapter 07.indd 130 5/18/2012 11:44:32 AM

Therefore, in a panel discussion the purpose is to present different views. Speakers sit the whole time
in front of the audience and each speaker presents their perspectives pertaining to the issue.
9.2. Members Involved in Panel Discussion

Panel discussion involves the following group members:
❑❑ Moderator: they are the time managers and act as a chairperson/facilitator/leader during discus-
sion. They are responsible for overall coordination of the panel discussion.
❑❑ Panelists: these are the experts who are the main speakers of the panel.
❑❑ Audience: they are usually passive listeners. Sometimes the moderator may allow them to ask
questions.
9.3. Execution of Panel Discussion

❑❑ Members of the panel (usually 5–7 in number) sit together in front of the audience on the dais. The
moderator assumes their position at the end of panelists.
❑❑ The moderator introduces the panelists and announces the time limits for each member.
❑❑ The moderator opens the panel discussion by inviting the first panelist to speak.
❑❑ When all the panelists have delivered their view points regarding the area of concern, the modera-
tor summarizes and concludes the session.
❑❑ Sometimes the moderator may open the floor for discussion.
9.4. Guidelines for Panelists

❑❑ Make sure that they are masters on your topic.
❑❑ Avoid addressing people with their first name unless they are asked to do so.
❑❑ Make no bias on their opinions and proofs.
❑❑ Observe cultural diversity of the panel opponents/members.
❑❑ Use languages that are easily understandable and comprehensible.
❑❑ Speak their opinions/suggestions clearly and accurately.
❑❑ Consider the private aspects of the entire panel that will affect their level of interest and their
feelings.
❑❑ Avoid stereotyping while delivering a speech.
9.5. Pros of Panel Discussion

❑❑ Allows experts to present different opinions or viewpoints concerning the topic under discussion.
❑❑ It has the capability to provoke better discussion than a one-person discussion.
❑❑ Frequent change of speaker keeps attention and interest of the students.
9.6. Cons of Panel Discussion

❑❑ Experts may not be good speakers to speak on the topic of interest.
❑❑ Sometimes personalities of the experts may overshadow the content of their speech.
❑❑ Subject may not be in logical order, so the discussion may move out of track.
Chapter 07.indd 131 5/18/2012 11:44:32 AM

10. SYMPOSIUM
The word symposium originated from the Greek word “sympotein” which means “to drink together”.
Symposium as a teaching method refers to any academic conference which is based on an open discus-
sion format. A series of speeches is delivered by speakers to explore various aspects of a problem or issue
and each speaker contributes by presenting a particular aspect of the issue or problem. In other words, it
is a collection of opinions expressed or articles contributed by several persons on a given subject or topic.
The moderator or chairperson of the symposium is responsible for controlling the overall process
of the symposium. At the outset of the symposium they introduce the speakers to the audience and in-
vite them one by one to present their speeches. The moderator has to manage the time limit allotted to
each speaker and when all speakers have finished their speeches they open the floor for discussion and
redirects the questions asked by audiences to the concerned speakers. The chairperson makes the final
concluding remarks and closes the session. It may be a good method to teach multidimensional nursing
problems and issues by splitting them into three or four speeches which are followed by a discussion.
Therefore, it has become an integral part of the national and international nursing conferences.
10.1. Pros of Symposium

❑❑ It is a useful method to explore a complex problem or issue.
❑❑ It is a useful method of teaching when a group is very large.
❑❑ It provides consolidated knowledge on a particular issue or problem in a short time period.
❑❑ It is a more enjoyable method as compared to traditional teaching methods because the students
have different experiences with different speakers and speeches thereby breaking the monotony
of traditional classroom teaching.
10.2. Cons of Symposium

❑❑ It requires a lot of time to plan a symposium.
❑❑ It requires a number of personnel to organize the symposium.
❑❑ Money also may be an issue.
11. WORKSHOP
In our day-to-day life we frequently use the word “Workshop” to refer to a room, area, or small estab-
lishment where manual or light industrial work is done. The term workshop has been borrowed from
the discipline of engineering. In these workshops engineering students have to do some task with their
hand to produce something.
In the context of teaching and learning, workshop refers to an educational seminar, or series of
meetings, or a brief intensive course which emphasizes problem solving, interaction and exchange of
information among a small group of participants. It is similar to a seminar but with a greater degree of
attendee participation, interaction and hands-on exercises. It is usually held for a full day (six hours)
where participants learn and practice the knowledge and skills. Therefore, workshop as a method of
teaching includes a blend of strategies (mini-lecture, group activities, exercises and presentation) for
teaching specific nursing subjects or portion of curriculum.
In a typical workshop, a group of 10–25 persons are assembled together to share a common interest
or problem. They meet together to improve their skills on a subject through intensive study, research,
practice and discussion.
Chapter 07.indd 132 5/18/2012 11:44:32 AM

The focus of a workshop is on hands-on skills, small-group activity, problem solving, small-group
discussions, etc. It results in active learning, and therefore retention of learning is better. It is a particu-
larly important teaching strategy for higher education as it is helpful in achieving the aims of higher
learning, which are to develop the capacity to respect the views and ideas of others as well as to present
own ideas and seek clarification.
11.1. Organization of Workshop

Generally workshops are organized for three to ten days. In special cases the period of a workshop may
be as long as 40 days. It depends on the nature of task assigned to the workshop. A workshop is usually
organized in three stages which are as follows.
First Stage
In the first stage the workshop coordinator advertises or communicates the theme of the workshop to
potential participants to create awareness regarding the workshop. Time, date and venue of the work-
shop are also communicated through the invitation letter to all concerned. The participants are advised
to register themselves in advance so that necessary arrangements (accommodation, stationary, meals)
can be made by organizers. Resource persons or experts are identified and invited to deliver content on
the topics assigned to them.
Second stage
The workshop is inaugurated by a renowned person in the field of nursing after which the workshop is
formally started. Experts present their views and discussion as per the given schedule which is prepared
in advance. The trainees or participants are given opportunities to seek clarification on any issue of
interest related with the theme of the workshop. The experts provide suitable illustration and examples
to clarify the doubts and queries of the participants.
The group is divided into small groups and a source person, or expert is assigned to provide guidance
for the work to be performed. The expert provides guidance and supervises the work of each trainee
of his group. Every participant has to work individually and independently to complete the given task
within the given period. At the end they meet in their groups and discuss and present their work.
Third Stage
Groups meet at one place and present their reports of work done in the second stage. The participants are
given the opportunity to comment and give suggestions of different aspects of the reports. Formalities
are observed at the end of the workshop.
Follow up
A follow up program is an important part of a good workshop. The trainees are asked to continue their
task and examine its workability and usability at their institutions. The participants are invited to meet
again and present their experiences regarding applicability of the topic or new practices.
Areas of Nursing for Workshop Technique

❑❑ Workshop on teaching–learning strategy.
❑❑ Workshop on Micro teaching.
❑❑ Workshop on test construction.
Chapter 07.indd 133 5/18/2012 11:44:32 AM

❑❑ Workshop on research methodology.

❑❑ Workshop on emergency Nursing.
❑❑ Workshop on ECG analysis.
❑❑ Workshop on Basic life support and advanced life support.
❑❑ Workshop on designing a program for teacher education.
11.2. Roles in Organizing a Workshop

Organizer: The program schedule is prepared by the organizer. He has to arrange for boarding and lodg-
ing facilities for the participants as well as the experts. He is responsible for the overall coordination of
the workshop.
Convener: The convener is nominated or invited who is well acquainted with the theme and the work-
shop. He or she has to conduct the workshop when the theoretical aspects of the topics related with the theme
are being discussed by the experts as well as observe the formalities and deliver the key note of the workshop.
Experts or Resource persons: Resource persons play an important role in providing theoretical and
practical aspects of the theme. They provide guidance to participants at every stage and train them to
perform the task effectively.
Participants or Trainees: The participants should be keen or interested in the theme of the workshop.
At the first stage, they have to acquire an understanding of the workshop’s theme. At the second stage,
they have to practice and perform the task with great interest and seek proper guidance from the experts.
The effectiveness of any workshop depends upon the involvement of the participants in the task.
11.3. Pros of the Workshop Technique

❑❑ It is especially helpful to realize the higher cognitive and psychomotor learning objectives.
❑❑ It is helpful for developing and improving professional efficiency among nurses.
❑❑ It enables the nursing faculty to act as the “guide on the side,” rather than as a “sage on the stage.”
❑❑ It does not focus on merely giving information to the students. Rather, it creates such learning
experiences that direct and facilitate the acquisition of new knowledge by the learner.
❑❑ It develops the feeling of group work or team work (cooperative learning) among participants.
❑❑ It provides a good platform to introduce new nursing practices and innovations in nursing educa-
tion, administration, etc.
❑❑ It results in active rather than passive learning.
11.4. Cons of the Workshop Technique

❑❑ A workshop cannot be organized for large groups.
❑❑ Participants may not take interest in practical work, instead they start enjoying the program for
fun, meeting people, etc.
❑❑ It requires a lot of time from participants and staff to organize the program.
❑❑ A large number of staff members are needed to handle participants (registration committee, stage
committee, lunch dinner committee, accommodation committee, etc.)
❑❑ It demands special facilities or materials that may not be available in budget-limited nursing
institutions.
❑❑ Generally follow up programs are not organized, which results in dilution of purpose of the workshop.
Chapter 07.indd 134 5/18/2012 11:44:32 AM

12. PROJECT METHOD

This method is commonly used by engineers, architects, in agriculture, industry courses and social
sciences as a teaching–learning strategy. It helps to cultivate independence and responsibility as well
as provide and opportunity to the students to practice social and democratic modes of behavior and
combine theory with practice.
The project method is considered a product of the American progressive education movement. It was
first defined and detailed by William Heard Kilpatrick (1918) in his essay, “The Project Method” which
became well known worldwide.
Kilpatrick’s concept is usually illustrated through the “typhoid project,” a world-renowned undertak-
ing reported by Ellsworth Collings in 1923. When 11 pupils from the third and fourth grades discovered
that two of their classmates had fallen ill with typhoid, they decided to explore how the infectious
disease was caused, spread, and combated (1923). The children worked on their own, without help and
interference from their teacher or direction from a formal lesson plan. It was their research and activities
that the sick classmates recovered quickly and the community was never again plagued by typhoid fever.
Kilpatrick was influenced by Dewey’s theory of experience and Edward L. Thorndike’s psychology
of learning when he was conceptualizing the project method. According to the Dewey’s theory of expe-
rience, children gain knowledge and experience by solving practical problems in a social environment.
Thorndike’s “laws of learning” explains that there are more chances of an action to be repeated for which
their “inclination” is procured “satisfaction” as compared to those action that “annoyed” and took place
under “compulsion”. On the basis of these theories Kilpatrick originally conceived that project work
should be selected by the students themselves and it should not be assigned by the teacher to the students.
Kilpatrick (1925) defined the project as a “hearty purposeful act”. Project-based learning involves
an individual taking on an issue/problem close to their hearts, developing a response or solution, and
presenting the results to a wider audience. A project may take only a few days to several months. He
mentioned that the purposes of the project should be decided by the students freely and should not be
dictated by the teacher. In some situations, the purpose may expire and if the teacher still requires the
completion of the project, then it becomes a task not a project. He argued that whatever problem/topic/
area the student undertook, as long as it was “purposefully” done, it was a project. Although the project
sometimes even may not require active doing and participating by the student; for example, the students
who presented a play on HIV/AIDS executed a project as well as those students who heartily enjoyed
it as audience.
The following activities may be considered as a project if done purposefully by the student.
1. Observation report to water purification plant/Cath lab.
2. Solving a mathematical problem/drug dose calculation.
3. Learning Chinese vocabulary/medical terminology.
4. Analysis of outbreak of polio.
12.1. Phases of Project

According to Kilpatrick, projects have four phases which are as follows.
❑❑ Purposing.
❑❑ Planning.
❑❑ Executing.
❑❑ Judging.
Chapter 07.indd 135 5/18/2012 11:44:32 AM

In an ideal situation of the project method all four phases should be initiated and completed by the
students and not by the teacher. When the students are provided with liberty of action they become
independent and acquire power of judgment. The project method focuses on group aspects of learning
than in cognitive development.
12.2. Broader View of the Project Method

In 1920, a growing number of teachers began to define the project method more broadly and considered
it to be a viable “general” method of teaching.
John Dewey criticized Kilpatrick’s view of an ideal project. Dewey argued that students by themselves
were incapable of planning projects and activities and they needed the aid of a teacher who would ensure
the continuous process of learning and growth. A project should not be an “enterprise of the child”; rather,
it should be a “common enterprise” of the teacher and pupils (Dewey, 1938; Kilpatrick, 1927). Contrary
to Kilpatrick, Dewey emphasized the role of the teacher in providing guidance and direction to students.
According to Dewey, all teaching methods were based on scientific thought and the method of educa-
tive experience. The project method, however, differed from the other procedures by requiring a kind of
problem solving, which—like building a boat or making a kite—was designed to challenge and develop
the constructive skills of the pupils (Dewey 1933).
12.3. Teacher’s Role

❑❑ Guide and a facilitator.
❑❑ Leadership skills that allow teachers to help a group of learners to move in the direction in which
they want to go.
❑❑ Pointing out potential pitfalls or making suggestions without getting defensive when students
decide they like their own ideas better.
12.4. Problems in the Project Method

❑❑ Some teachers are too inexperienced to guide the process, resulting in confused and discouraged
students.
❑❑ A teacher may expect too much ability on the part of the learners to take control of the project without
having laid the necessary groundwork, or they may fail to let students take the lead when they can.
❑❑ Learners may not take project work wholeheartedly.
❑❑ Some students may feel teachers are abdicating their roles if they do not provide answers, or they
may not want to learn with and from their classmates.
12.5. Strategies to Overcome Problems in the Project Method

❑❑ One or two hours per week seems optimal for project-based learning in non-intensive classes.
❑❑ In cases where both learners and teachers are new to project-based learning, infusing the curricu-
lum with multiple opportunities for group discussion and decision making can ease the transition.
❑❑ If adult learners decide to take on a project, they need sufficient time to plan, revise, implement
and reflect on the project before it is presented to others.
❑❑ The guide should make sure that time lines and responsibilities that the group has mapped out be
reminded to them as per the status of a project.
Chapter 07.indd 136 5/18/2012 11:44:32 AM

12.6. Pros of the Project Method

❑❑ At the beginning and the end of projects, learner enthusiasm seems to be increased, fortifying
classes and teachers.
❑❑ Since students have signed on to an issue that interests them, motivation tends to be high.
❑❑ As learners get involved in the inquiry process, they become curious about answers, often digging
deeper into a topic and spending more time on a task than they do when a teacher assigns group
work.
❑❑ A shared work ethic is created.
❑❑ Learners frequently encourage each other and lend moral support as they face the frightening
prospect of a public presentation.
13. ROLE PLAY

Role play is an important teaching–learning strategy to teach attitude to nursing students. An attitude
is a dispositional readiness to respond to certain situations, persons or objects in a consistent manner,
which has been learned and has become one’s typical mode of response.
An attitude has a well-defined object of reference. For example, one’s views on HIV/AIDS, breast
self-examination, basic life-support techniques, etc., are attitude. Developing a good attitude among nurs-
ing students toward patients care, bed-side nursing, etc., is of vital importance in the nursing profession.
13.1. Definition
A role is “a patterned sequence of feelings, words, and actions …. It is a unique and accustomed man-
ner of relating to others” (Chesler and Fox 1966). Therefore, role play refers to a method of teaching
in which a situation is staged or played by a group of students who play roles of different characters as
required by the situation according to a prewritten script under the direction of the teacher for deriving
useful learning experiences.
The role-playing process provides a live sample of human behavior that serves as a vehicle for
students to: (1) explore their feelings; (2) gain insight into their attitudes, values, and perceptions; (3)
develop their problem-solving skills and attitudes; (4) explore subject matter in varied ways.
For example, role play or Nukkad Natak by a group of nursing students may be undertaken to spread
the message of HIV/AIDS among lay people. With the help of role play various aspects of HIV/AIDS
may be depicted, e.g., modes of transmission, general manifestations and treatment of HIV/AIDS, group
of people at risk of HIV/AIDS, myths associated with HIV/AIDS and so on. Similarly, counseling tech-
niques may be taught to nursing students in the classroom by role playing various real-life situations.
Thus, role play represents real-life situations of some problems for gaining insight into various aspects
of a problem. When students perform a role they can feel the characters enacted by them (e.g., HIV
patient, nurse, doctor, relatives); they view the problem from the patient’s point of view and not from a
healthcare personnel point of view, and it makes them more sensitized towards the care need of patients.
13.2. Difference Between Role Play and Simulation

Though the concept of role play is not new but some scholars did not find agreement on the definition
of the term. Such words as role play, simulation, and drama are sometimes used interchangeably, but,
in fact, they illustrate different notions. Some scholars believe that the difference between role play and
Chapter 07.indd 137 5/18/2012 11:44:32 AM

simulation is in the authenticity of the roles played by students. Simulation is a situation in which the
students play a natural role, i.e., a role that they sometimes have in real life (e.g., providing CPR to a
cardiac arrest victim). Whereas, in a role play, the students play a part that they may not play in real
life (e.g., Health Minister, AIDS patient). The other scholars consider role play as one component or
element of simulation (Crookall and Oxford, 1990). Thus, in a role play, participants are assigned roles
which they act out in a given scenario. In a simulation, emphasis is on the interaction of one role with
another, rather than on acting out individual roles.
13.3. Prerequisites for Effective Role Play

❑❑ The students who engage in role play must clearly understand the situation and the roles to be
played by them for staging the scene of the given situation.
❑❑ The role or situation should have a real-life quality.
❑❑ All group members should be active participants either as role players or observers.
❑❑ Script of the play must be written clearly and communicated to all role players in advance.
❑❑ The script should touch all the aspects of the real life of a particular situation.
❑❑ Personality characters of a student should closely match with the character he or she is playing in
the role play.
❑❑ Objectives or theme of the role play should be stated clearly.
13.4. Steps in Role Play

According to Joyce and Weil (2000) a role play may involve the following steps. The teacher is respon-
sible for initiating the steps and guiding students through the activities within each step.
❑❑ Warm-up stage: citing of a problematic experience or creation of a problematic situation are the
important activities of this stage. It is just like the selection of a story for movie.
❑❑ Writing the script of play*: script should be written clearly touching all the aspects of the situation
intended to be learned by students. (* this step was not described by the Joyce et al.)
❑❑ Casting the role players: in this stage students are selected for playing various roles as per the
demand of the script. It will be better if the personality characters of a student are closely matched
to the character he or she is supposed to play. Students’ level of language proficiency should be
taken into consideration (Livingstone, 1983).
❑❑ Stage setting for role play: necessary environmental manipulations are done to meet the demand
of script so that observers can have a feel of real like situation. Effective environmental manipula-
tion contributes to the success of the play.
❑❑ Assigning the role of observers: observers’ roles are assigned to selected students. They are sup-
posed to actively observe the play and may recommend the necessary modifications before the
full dress rehearsal of the play. During the actual play they are also supposed to observe the play
and their comments may be incorporated for future enactment of the play.
❑❑ Enactment of the play: in this stage the role players play their role as per the script or the story re-
quirement under the manipulated environmental setting. The teacher should allow the enactment
to run only until the proposed behavior is clear, a character has developed, a behavioral skill has
been practiced, an impasse is reached, or the action has expressed its viewpoint or idea.
❑❑ Discussion and evaluation: this stage follows the enactment of the play. It includes the discussion
regarding the topic of interest, evaluation of the quality of role play and the effectiveness of the
Chapter 07.indd 138 5/18/2012 11:44:32 AM

roles played by various students. Analysis and discussion of the enactment are as important as
the role playing itself. Emotions and ideas can be brought to consciousness and enhanced by the
group discussion.
❑❑ Enacting again: this step is concerned with the reenacting of the play as per the modifications.
❑❑ Re-discussion and evaluation: in this step again the discussion and evaluation of replay is car-
ried out.
❑❑ Deriving generalization: this step is concerned with making relevant generalization and the useful
specific lessons to be implemented in real-life situations.
13.5. Pros of Role Play

❑❑ Role play provides an opportunity to the student to learn from the inside about a subject or situ-
ation. Students can feel the intensity of the problem/situation as well as the emotions, feeling
associated with a particular subject (e.g., HIV patient) by enacting the roles of various characters.
❑❑ Role play put the Nursing students into others’ shoes which may be useful to change the attitude
of the students towards a specific problem (attitude towards basic life support techniques or
HIV/AIDS).
❑❑ Through role playing, students can increase their abilities to recognize their own and other peo-
ple’s feelings, they can acquire new behaviors for handling previously difficult situations and they
can improve their problem-solving skills (Joyce and Weil, 2000)
❑❑ Nursing students can derive useful life experiences through playing various roles or actively ob-
serving the situation during role play which may be helpful for their future life activities.
❑❑ Role play stimulates interest and it motivates the student to learn the right attitude about a subject
or phenomena of interest.
❑❑ It is a useful method to teach attitude, verbal and nonverbal communication techniques, counsel-
ing techniques and social etiquettes.
❑❑ Risk-free opportunities are provided to nursing students to practice clinical and decision-making
skills.
❑❑ Students have reported increased understanding of course material, and faculty have reported de-
creased failure rate in the exam with the use of role play as a teaching method. (Comer SK, 2005.)
13.6. Cons of Role Play

❑❑ Sometimes students may take it as a method of amusement/entertainment which may not result
in learning.
❑❑ Students may not believe in the story or the situation enacted by the role play. In this situation role
play loses its significance and importance.
❑❑ Effective role players may not be easily available. Without effective role players, the role play
may become a stage for recreation.
❑❑ Time-consuming activity on the part of the teacher (requires considerable time for writing script,
selecting role players, observers, arranging necessary articles for environment manipulation etc.).
❑❑ Students may not grasp the problem and may not act accordingly.
❑❑ May interfere with cultural or belief system of participants. Student may get offended with
criticism.
Chapter 07.indd 139 5/18/2012 11:44:32 AM

14. FIELD TRIP

Field trip has been described as the oldest old audio-visual aid or teaching strategy. Field trip allows stu-
dents to put the concepts and ideas which are discussed in the classroom into a real-world context. Field
trips would often be followed by class discussions or sometimes may precede the classroom teaching.
A field trip is defined as any teaching and learning experience outside of the classroom in the real-
world setting, where students have concrete experience of the content they have learned in theory.
“Naturalism” a philosophical school of education greatly emphasized field trip as a method of teaching.
Field trip serves the purpose of making a connection between reality and theory. It can be used as
an introduction to a unit or a culminating activity to provide an authentic learning experience. Students
can experience all five senses: see, touch, hear, smell and taste during the trip. Nursing students usu-
ally make field trips to old-age homes, water purification plants, sewerage plants, milk dairies, waste
disposal plants, etc., as per their curriculum requirement.
14.1. Planning for a Field Trip

The success of field trip depends on how well it is planned and organized by the teacher. The teacher
has to decide about factors below listed while planning the field trip.
❑❑ Objectives of the field visit: ensure the field trip compliments the curriculum by meeting specific
expectations.
❑❑ Check for the college policy on field trips.
❑❑ Identify the institution or agency or any other place which will be most suitable for the field trip
as per the objectives of the visit.
❑❑ Obtain prior permission from the institution which is selected for the trip.
❑❑ Identify the facilities available at that institution and plan accordingly.
❑❑ Decide on the number of teachers required for the trip (student–teacher ratio).
❑❑ Arrange for transportation, send request to transportation department with date and time of de-
parture and arrival.
❑❑ Raise funds as per the requirement.
❑❑ Ensure students have necessary background knowledge prior to the field trip.
❑❑ Prepare and supply the list of articles that the students should bring before going for the trip.
❑❑ Inform the exact time, venue and date of departure to the students.
❑❑ Prepare a list of rules with students that must be observed during the field trip.
❑❑ Plan post-trip activities that build on the knowledge gained in partaking in the field trip (e.g.,
observation reports, models, charts etc.).
❑❑ Prepare a checklist to ensure that all tasks are completed (e.g., booking facilities and transporta-
tion, supervision, safety precautions, emergency information).
❑❑ Be sure to visit the site ahead of time in order to plan for safety, to learn about resources, resource
personnel and facilities available at the site.
❑❑ There are many potential liability situations that can occur on a field trip; it is the ultimate respon-
sibility of the teacher to ensure safety of the students.
❑❑ Set behavioral expectations for the field trip and discuss them with the students prior to departure.
❑❑ Describe the consequences for not behaving properly prior to embarking on the trip.
❑❑ Ensure that the student–supervision ratio is sufficient to supervise the students effectively.
Chapter 07.indd 140 5/18/2012 11:44:33 AM

❑❑ Ensure that safety gear and first-aid equipment are readily available and in plain view.
❑❑ Plan for en route activities to enrich their experience during the field trip.
14.2. Follow Up and Evaluation

After the field trip, open group discussion is carried out in the classroom to discuss the outcome and
effectiveness of the trip. It also provides information and important points that have to be considered for
future trips. Sometimes, students may be asked to prepare a report, project or model following the trip
that provides them with another learning experience as well as strengthen the knowledge gained during
field visit. A written test may also be conducted to evaluate the learning outcomes of the trip.
14.3. Pros of Field Trip

❑❑ Students get real–life, concrete experiences which enrich their learning.
❑❑ Learning is long lasting.
❑❑ Provides opportunity to relate theory with the practical experience.
❑❑ It helps to develop observation and keenness among the students.
14.4. Cons of Field Trip

❑❑ It is a time-consuming activity.
❑❑ Requires a lot of planning on the part of the teacher.
❑❑ Safety precautions are required.
❑❑ Requires a number of teachers to accompany students if the student group is large.
15. EXHIBITION
An exhibition is an organized presentation and display of selected items/objects. “Exhibit” refers to a single
item being exhibited within an exhibition; it is the pieces of work done by the students for an exhibition.
Exhibition involves assembling, arranging and displaying communication media to depict a central-
ized theme which is aimed to inform the students about a topic. The communication media may include
objects, models, specimen and motion pictures, etc.
Students can be asked to prepare models, charts and puppets according to a pre-decided theme and
can display their work in the exhibition hall for a specified duration. Exhibition as a teaching method
can be used to teach operation theater equipments, history of nursing and so on. Sometimes, an exhibi-
tion can follow a workshop to display the work done by participants in workshop.
Though exhibitions are common events, the concept of an exhibition is quite wide and encompasses
many variables. Exhibitions can range from an extraordinarily large event such as an international trade
fair to a display of just one item.
15.1. Planning for the Exhibition

❑❑ Students should be involved as much as possible in the planning of the exhibition.
❑❑ Decide the objectives of the exhibition and accordingly choose the central and sub themes or title
for exhibition. For example, “Exhibition on drugs used in obstetrics”, “Exhibition on history of
nursing” etc.
Chapter 07.indd 141 5/18/2012 11:44:33 AM

❑❑ Objectives of exhibition should supplement the curriculum learning objectives.

❑❑ Plan the date, time and venue for the exhibition and inform all concerned.
❑❑ Venue of the exhibition should be well lit, ventilated, and should provide hassle-free movements
of the students so that they can rotate around the exhibition without any obstacle.
❑❑ The concepts of contrast in color and size should be used to make exhibitions attractive.
❑❑ Decide the number of stalls for models or panels for posters to be installed for the exhibition.
There should be provision of focus light at each stall to make the displayed items well lit.
❑❑ Select a group of students for each stall or panel of posters who will be responsible for preparing
and exhibiting the material as suggested by the teacher.
❑❑ Prepare the budget for the exhibition and ensure that students are supplied with required material,
e.g., posters, thermocol, glitter pen, and any other material required.
❑❑ Encourage the students to use innovative and creative ideas while preparing posters, models or
any other material for exhibition.
❑❑ The exhibits should be clean and labeled properly
❑❑ The exhibits should be placed at proper height so that visitors can have a look at them.
❑❑ Plan and arrange for the provision of basic facilities at the site of exhibition if it is planned outside
the college campus.
15.2. Pros of Exhibition

❑❑ It enriches learning experiences of the students.
❑❑ Students are actively involved and learn by preparing the exhibits and observing the displayed items.
❑❑ It’s a good strategy to supplement classroom teaching.
❑❑ Students learn how to work in team and group dynamics
❑❑ It helps to develop social skills of communication , cooperation and coordination among students.
❑❑ Exhibitions foster creativity among students.
15.3. Cons of Exhibition

❑❑ Time- and resource-consuming activity.
❑❑ Requires a lot of planning and implementation on the part of the teacher and students.
16. CLINICAL TEACHING METHODS

“To study the phenomena of disease without books is to sail an uncharted sea. Whilst to study
books without patients is not to go to sea at all.”
(Osler 1849–1919)
Teaching in a clinical setting is entirely different as compared to teaching in other settings (e.g., class-
room, laboratory, etc.) because in the clinical area there are real situations with real patients as compared
to hypothetical situations created in classroom teaching. It provides an ample opportunity for a student
to observe the various nursing procedures, day-to-day routines of staff nurses which is important for
them to prepare themselves for their future roles. Sound theoretical knowledge base is a prerequisite
to learn better in the clinical area. In India, the nursing profession is struggling with incongruence of
what is taught in theory classes with what is applicable in practice. In theory classes, students are taught
Chapter 07.indd 142 5/18/2012 11:44:33 AM

e xtensively about how to write nursing care plans, how to prioritize the patient’s needs, etc., but in
practice care plans are missing and nurses are not applying theoretical knowledge in the clinical setting,
therefore, it is a major issue which must be taken care of by the nurse leaders and professional organiza-
tions of the country. Clinical area provides an ample opportunity for a nurse teacher to teach the students
in the context of real-world situations. Since the clinical area is different from the classroom in terms
of environment, context and availability of resources, the nurse teacher has to adopt different teaching–
learning strategies. A well-planned clinical teaching program is important for making valuable contri-
bution to the nursing student’s learning. When it is planned in consultation with the college of nursing,
hospital and unit staff, the student will gain the maximum. The learning objectives are then clear to all
members taking part in the clinical teaching program. The teacher has to play a variety of roles (guide,
counselor, researcher, advocate and so on) in clinical settings to facilitate learning among students.
16.1. Definitions of Clinical Teaching
“It is the vehicle that provides students with the opportunity to translate basic theoretical knowledge
into the learning of a variety of intellectual and psychomotor skills needed to provide the patient-
centric quality nursing care”
—Scheweer (1972)
“It is preparing students to integrate previously acquired basic science information with
performance-oriented skills and competencies associated with the diagnosis, treatment, and care of
patients, and to acquire the kinds of professional and personal skills, attitudes and behaviors thought
essential for entering the healthcare system and embarking on continuing forms of education”
—Meleca et al (1978)
“Clinical teaching in its focus on the relationship between theory and practice, can assist students
to not only apply theory, but also to search the ways that nursing theory can emerge from the rich
texture of clinical practice”
—Benner (1989)
16.2. Value of Clinical Teaching

Clinical teaching is a valuable tool in the hands of a teacher to make the student expert in clinical compe-
tencies through working with them in real-life scenarios. Clinical teaching puts theoretical learning of the
students in the clinical context and prepares them for the kind of work they are supposed to perform as a
professional nurse by showing them how clinical nurses use their clinical and generic skills in their day-to-
day clinical work. The performance of a clinical nurse used to show the nursing student how things should
be done is called role modeling. Students have an excellent opportunity to observe how professional
nurses interact with patients, members of healthcare team and administrative staff, how they manage to
take phone calls in heavy workload areas, how they manage angry patients and their family members and
how to deal with tearful patients or family members. The students also have ample opportunity to observe
how professional nurses perform routine procedures, examine patients and communicate bad news to the
patients’ relatives. These important professional activities cannot be learned through text books alone.
Research evidence suggests that 50% of clinical time is spent in seminar rooms, 25% at bedside and
less than 5% time for students to demonstrate their clinical skills. This situation calls for aggressive
planning and improved strategies for clinical teaching on the part of the clinical instructors and tutors.
Cox (1993) provided a model for clinical teaching which is given in Figure 7.1.
Chapter 07.indd 143 5/18/2012 11:44:33 AM

Clinical Encounter
Debricfing
Experience
Cycle
Preparing
Preparation for next

Explanation patient
Working
Knowledge Cycle Reflection
Explication
Figure 7.1 Cox (1993) Model for Clinical Teaching
Presently, much of the clinical teaching involves students as passive observers despite the fact that the
clinical scenario provides an excellent opportunity to use a variety of interactive, stimulating teaching
strategies. Therefore, the role of the teacher is much more important to exploit the available opportuni-
ties for the benefit of nursing students. A nursing faculty can use the following teaching–learning strate-
gies in a clinical setting.
❑❑ Bedside clinic.
❑❑ Nursing rounds.
❑❑ Nursing reports.
❑❑ Individual conference.
❑❑ Group conference.
❑❑ Nursing care plan.
❑❑ Nursing case study.
❑❑ Nursing case presentation.
❑❑ Process recording.
17. BEDSIDE CLINIC

It is a teacher-centric method useful for small groups of students (not more than 10–15 students). It is
conducted by the clinical instructor or nursing faculty or sometimes by a clinical nurse educator, doctor,
or ward incharge.
Chapter 07.indd 144 5/18/2012 11:44:33 AM

❑❑ Bedside clinic is conducted in the presence of the patient. It can be medical, nursing or combined
(based on type of topic). Prior information to group about patient and venue is provided by the
concerned nurse educator or clinical instructor. The teacher has to select a topic and a patient with
typical signs and symptoms.
❑❑ The patient’s or relative’s consent should be taken to conduct bedside clinic.
❑❑ Brief the patient about the aim of the bedside clinic, students’ numbers and the level of students
and what the student will do and for how long.
❑❑ Brief the students about the rules for session, e.g., what to discuss or not in front of the patient.
❑❑ Duration of discussion should be 30–45minutes and it should focus on signs and symptoms, his-
tory of the patient, diagnostic tests, medications, possible complications, and the comprehensive
nursing care plan of the patient.
❑❑ The teacher should make sure that nothing should be done or told which may humiliate or embar-
rass the patients and their relatives.
❑❑ Focus of discussion should be on total care of the patient.
❑❑ Clarification, summarization and evaluation are done at the end of the clinic.
Nair BR, Coughlan JL, Hensley MJA conducted a cross-sectional study at University of Newcastle,
Australia to obtain the opinions of clinical teachers about bedside teaching including perceived
hindrances to its implementation. Ninety-five per cent of the teachers reported that bedside teach-
ing is an effective way to teach professional skills. Time constraints, noisy wards and patients not
being available were reported as the most frequently experienced hindrances to bedside teaching.
The survey found strong support for bedside teaching but a substantial number of barriers to its
implementation.
18. NURSING ROUNDS

The aim of teaching rounds is to acquaint student nurses with all patients in the ward so that better
understanding and more purposeful care may be achieved for each patient. Usually all the patients are
visited on rounds and the visit is accompanied by a discussion pertaining to each patient’s care.
❑❑ The patients’ history and the medical aspects of their care are included only as a background for
understanding of the nursing care.
❑❑ Instead of one patient being demonstrated, all of the patients are presented briefly.
❑❑ The student nurses should be informed ahead of time about it. This helps them to prepare them-
selves for the learning experience.
❑❑ Students may be taken around the ward, stopping briefly at the bedside of each patient for a short
discussion of the most significant nursing problem.
18.1. Pros of Nursing Rounds

❑❑ Students learn to differentiate the needs of different types of patients admitted in a ward. Nursing
rounds provide them with the opportunity to learn variety of medications, diagnostic tests, and
more importantly how to recall data of similar types of patients simultaneously.
❑❑ It provides an opportunity to the clinical instructor to test the students’ knowledge of various dis-
orders and treatment and nursing management.
Chapter 07.indd 145 5/18/2012 11:44:33 AM

18.2. Cons of Nursing Rounds

❑❑ If a group of students is large, the teacher may not be able to pay attention to all students; the at-
tention of individuals who are in the periphery is lost.
❑❑ If the students do not come prepared for nursing rounds it may not lead to effective learning.
19. NURSING REPORT

Nursing reports are brief descriptions of major clinical events, vital signs, diagnostic tests and nurs-
ing interventions related with a single patient. In another form, it may be brief descriptions of clinical
events, medical and nursing interventions related with all the patients admitted in a ward. Nursing
reports serve as means of communication between staff nurses and nursing supervisors. It provides a
learning opportunity to nursing students by providing brief but comprehensive overview of patient situ-
ation, milestones towards recovery or deterioration of the patient condition, etc. The students also learn
about important information that must be communicated about patients while taking over duty during
shift change. A verbal nursing report serves as useful learning experience by inculcating public speaking
ability and confidence in presenting information among nursing students.
20. INDIVIDUAL CONFERENCE

Individual conference is a student-centric teaching strategy in clinical area. It may be of two types:
planned and unplanned or incidental.
It especially deals with the individual student’s clinical competence, care ability, nursing skills, per-
formance and achievements related to clinical experience. The clinical instructor, while organizing in-
dividual conference, should respect individuality, provide a comfortable atmosphere which is conducive
to learning and maintain a record of the conference.
20.1. Pros of Individual Conference

❑❑ It takes care of learning difficulty of individual students and encourages them to overcome it.
❑❑ Boosts self-confidence and sense of security among students.
21. GROUP CONFERENCE

It is a small group teaching method (i.e., not more than 10–12 students). In a group conference, a group
of students and their instructors meet for an informal discussion of clinical problems. A subject of com-
mon interest related to the clinical area is discussed. Suggestions derived from the various group confer-
ences are informed to the head nurse.
21.1. Role of the Clinical Instructor in Leading Group Conference

❑❑ They must be sensitive to the group.
❑❑ Should be poised and have patience.
❑❑ Guide the discussion.
❑❑ Correct wrong impressions.
❑❑ Choose the area or subject of discussion.
Chapter 07.indd 146 5/18/2012 11:44:33 AM

21.2. Pros of Group Conference

❑❑ Helps students to develop problem-solving and team-building skills, and the ability to express
themselves assertively.
❑❑ It provides an opportunity to express innovative ideas and to refine clinical skills.
❑❑ It awakens interest and appreciation among students.
22. NURSING CARE PLAN

It is a learner-centric clinical teaching method which provides guidelines for individualized patient care.
A daily plan is made based on the priority needs of the individual patients assigned to student nurses for
care. Students are required to write, implement and evaluate the planned care and modify the written
plan of care to meet an individual patient’s need.
22.1. Pros of Nursing Care Plan

❑❑ Helps students to learn prioritizing nursing care needs of different patients.
❑❑ Students learn how caring needs fluctuate from patient to patient and over a period of time.
❑❑ Post-graduate students can learn how to apply various nursing theories into clinical practice by
preparing care plans according to different formats provided by different nursing theories.
❑❑ Helps to provide more complete, comprehensive, unified and need-based care of individual patients.
23. NURSING CASE STUDY

Nursing case study is a detailed study of the patient while providing care to that patient by a student
nurse. Case study is also considered as a method of research. Usually, a rare clinical disorder is selected
for the case study and the assigned student nurse follows that patient for a particular period with an
intention to develop comprehensive nursing care abilities. The patient is selected by the student in con-
sultation with the clinical instructor or ward nurse.
❑❑ The student makes an in-depth study of the patient and his/her problems.
❑❑ The student has to provide nursing care to the patient for a long time.
❑❑ The student presents the case study to the class or group for a discussion.
❑❑ A written guide should be given to the student on lining the types of information.
23.1. Pros of Nursing Case Study

❑❑ Increases understanding of the wide range of nursing problems associated with the selected dis-
order.
❑❑ Provides opportunity for the students to solve nursing problems and provide comprehensive nurs-
ing care to the patient.
❑❑ It helps record nursing observations in an organized and systemic way that can be presented in
front of a group for discussion.
❑❑ Stimulates students to search related literature to have an in-depth understanding of the problem.
❑❑ Helps students to integrate and apply all their knowledge of the various subjects.
Chapter 07.indd 147 5/18/2012 11:44:33 AM

24. PROCESS RECORDING

It is an important clinical teaching–learning strategy most commonly used in the psychiatric ward.
According to Hudson, process recording is an exact written report of the conversation between the nurse
and the patient during the therapeutic interaction. Process recording can serve some important purposes
which are as follows.
❑❑ It can be used as a teaching tool.
❑❑ It can be used as a self-evaluation tool.
❑❑ It can be used as a therapeutic tool.
24.1. Phases in Process Recording

❑❑ Student is prepared for process recording.
❑❑ Interaction with the patient and recording of the interaction.
❑❑ Evaluating the interactions by the instructor and the student.
24.2. Pros of Process Recording

It helps the students to develop the following skills.
❑❑ Communication skills.
❑❑ Interaction pattern.
❑❑ Infer verbal and nonverbal cues to the patients’ need.
❑❑ Skills in meeting the patients needs.
24.3. Cons of Process Recording

❑❑ As a teaching–learning method it is very time consuming as students have to prepare for process
recording, interact with the patient and record it.
❑❑ Requires special skills, e.g., communication skill, writing ability and recall of memory etc.
25. COMMON PROBLEMS IN CLINICAL TEACHING

❑❑ Lack of clear objectives and expectations among the students.
❑❑ Passive observation rather than active participation of learners.
❑❑ Inadequate supervision and provision of feedback.
❑❑ Little opportunity for reflection and discussion.
❑❑ Informed consent not sought from patients.
❑❑ Lack of respect for privacy and dignity of patients.
❑❑ Lack of congruence or continuity with the rest of the curriculum.
26. PROBLEM BASED LEARNING

Problem Based Learning (PBL) is quite a new teaching–learning strategy incorporated in the nursing
curriculum which is especially useful for higher or adult education. Problem-based learning can be used
in classroom as well as in the clinical teaching–learning environment. Students and faculty sometimes
Chapter 07.indd 148 5/18/2012 11:44:33 AM

misconceptualize problem-based learning as merely a problem-solving technique; rather, it is a small

group teaching–learning activity leading to knowledge development and understanding among stu-
dents. Each member of the group utilizes own information, resources, and personal experiences in order
to get solutions to the open-ended problem.
PBL is based on a theory which is known as information processing approach to learning which
was initially described in the year 1977. This theory suggests that restructuring information with the
help of simulation (problem scenario) is important for effective acquisition of knowledge. When the
adult learners are presented with problem scenarios (within a realistic context about which they have
some pre-existing theoretical knowledge), it leads to acquisitions of new insight, new knowledge,
restructuring and application of knowledge, and to then elaborate on the new information they have
learned.
In problem-based learning, a small group of nursing students are presented with problem scenarios
by the faculty members, or the students may choose problem scenarios from their clinical areas on their
own. These problem scenarios which act as a stimulant may include video clips, family tree of a genetic
disorder, real patient in ward with atypical clinical problems, simulated patient and newspaper articles,
and sometimes the teacher may provide a problem scenario describing it on paper. Developing PBL re-
source material is a cumbersome job which requires a team of highly enthusiastic nursing faculty having
knowledge of principles of PBL as well as good facilitation skills.
After the assignment of problem scenarios by the teacher, the students formulate learning objectives.
Nursing faculty has to make sure that the learning objectives formulated by the students are consistent
with their teaching objectives. Thereafter, the students have to work independently, gather data, refer
books or the internet, gather relevant facts to understand and solve the problem and broaden their
knowledge and understanding. The students return back to problem tutorials to discuss their findings,
clarify doubts and refine the knowledge they have acquired during this process.
Nursing faculty who is an expert in a particular subject of nursing specialization may not necessarily
be an expert facilitator, which is the vital requirement of PBL. Therefore, staff development in the area
of facilitators’ skills and group dynamics must precede the introduction of PBL in nursing curriculum by
a college of nursing. Faculty need to be familiarized with the learning objectives, tools and techniques
of assessment in the context of PBL.
26.1. Problem Tutorials

Several rounds of problem tutorials are conducted for a particular problem scenario. A typical problem
tutorial consists of a nursing faculty (who is expert in problem-based learning as well as in the selected
problem scenario) and a group of students (6–10 in number). The Students elect a chairperson and a
recorder for the problem tutorial. The nursing faculty acts as facilitator of the PBL tutorial. In the be-
ginning of the session the chairperson reads out the problem case. If the problem case is a real patient
admitted in the ward, one student is asked to collect thorough nursing history of the patient before the
tutorial is held. With the progression of the tutorial learning material or resources may be provided to
the students. The teacher has to make sure that each group member is playing his role efficiently and the
group achieves the desired learning objectives.
26.2. Steps Involved in PBL Process

The steps of PBL process may vary from institution to institution but the core concept remains the same.
The steps involved in the PBL process are as follows.
Chapter 07.indd 149 5/18/2012 11:44:33 AM

Day 1: Session 1
Step 1: The facilitator presents the problem scenario before the group or sometimes the chairperson may
read out the problem scenario.
Step 2: Group members identify and clarify those terms presented in the problem scenario which are
unfamiliar to them. The recorder lists all those terms and their explanation.
Step 3: Define and analyze the problem or problems. It is important to consider view points of each
group member. Analysis of the problem requires brainstorming and pre-existing knowledge about the
problem among the group members. Areas of incomplete knowledge and tentative solutions are ex-
plored during group discussion. The group reaches an agreement on those areas which are important
and require further exploration.
Step 4: Group members formulate learning objectives on the basis of the problems which emerges in the
discussion step. Facilitators should keep an eye on the leaning objectives whether they are achievable,
comprehensive and as per the curriculum guidelines. Thereafter, group members are assigned with the
tasks they have carry out. The task can be assigned in terms of learning objectives and as per the level of
the student. The group is dispersed after summarization to seek and explore the information pertaining
to their task.
Step 5: The group member/s access the internet and research in the library to seek information neces-
sary to fulfill the particular learning objective which is assigned to them. Assistance is sought from the
facilitator whenever required.
Day 8: Session 2
Step 6: The group members along with the facilitator meet; each group member presents his or her find-
ings for group discussion. In this step, new questions may arise; the recorder lists the new knowledge
and skills acquired during the process of PBL. Sometimes, the group has to go back to the field to fulfill
the demand raised by new questions.
Step 7: The work done by the group is submitted to the facilitator who evaluates the work as per preset
criteria of evaluation. If the facilitator feels that the work done by the group is unsatisfactory then the
group has to go back to the field to seek more information as per the suggestions given by the facilitator.
26.3. PBL Scenarios

Good-quality problem-based scenarios are pivotal for the success of this teaching–learning strategy.
These scenarios must generate learning objectives which are congruent with the overall curriculum.
Some guidelines to formulate good PBL scenarios are as follows.
❑❑ Problem scenarios should provoke interest and challenge the students. Problems raising the is-
sues which are poorly handled by the staff nurses and faculty will be a good source of problem
scenarios.
❑❑ The problems must be formulated in a clear and concrete manner.
❑❑ Problem scenarios should lead to formulation of learning objectives by the students which are
consistent with their curriculum objectives.
❑❑ There should be balance between simplicity and complexity in problem scenarios according to
the level of the students.
❑❑ Scenarios should have hints that are sufficient enough to provoke group discussion and stimulate
students to search for explanations for the issues presented.
Chapter 07.indd 150 5/18/2012 11:44:33 AM

❑❑ The problems presented in problem scenarios should not be closed-type problems leading to com-
mon answers by the students; rather, they should be open-type problems having a range of pos-
sible answers, providing scope for problem-solving activity that will result in deep understanding
among the students.
❑❑ Scenarios should encourage the students to search for information from a variety of learning
resources.
(Adapted from Dolmans et al. Med Teacher 1997;19:185–9)
26.4. Role of Teacher in PBL

The role of the nursing faculty in PBL is radically different as compared to traditional methods of teach-
ings. In PBL, the faculty has to assume the role of facilitator, guide and leader of the overall process
to provide encouragement to the students and assistance whenever students face difficulty. Facilitating
the process of PBL is a skill which includes providing constructive criticism with thought-provoking
comments to guide the direction of learning. Merely providing facts and information to the students is
not sufficient and may compromise the process and outcome of PBL. The teacher must be familiar with
group formation strategies and handling the group discussion during PBL tutorials.
26.5. Pros of PBL

❑❑ It results in active and long-lasting learning and understanding.
❑❑ It makes the students a good resource locator.
❑❑ Helps to cultivate a range of interpersonal skills and attitude which might be helpful in future
practice, e.g., communication, prioritization of time, how to evaluate the literature critically, team
work, respecting views of others and task sharing.
❑❑ Students feel confident, independent, enthusiastic and owner of the problem and their learning. It
is an enjoyable process for adult learners.
26.6. Cons of PBL

❑❑ Time consuming to facilitate PBL on the part of the teacher. Developing resource material for
PBL Scenarios is a time consuming and difficult process.
❑❑ Faculty requirement: Nursing faculty who are not expert facilitators and guides may become help-
less, hence jeopardizing the process of PBL.
❑❑ May not be suitable to all nursing subject areas.
❑❑ Resource requirement: PBL requires a number of resources in terms of staff, library, and internet fa-
cility on a large scale to accommodate the needs of the students to use these facilities simultaneously.
27. PROGRAMMED INSTRUCTION

History and Background of Programmed Instruction
One might have gone through a CD in which there is series of questions which are presented one by one
on a computer screen with the user having to answer the question on the screen before proceeding to the
next question. As soon as the user answers a question they are provided with the response that their an-
swer is right or wrong. If the answer is wrong then the inbuilt software program informs the user about
Chapter 07.indd 151 5/18/2012 11:44:33 AM

the right answer with rationale for that question. The questions are presented in sequence of units of the
curriculum and become progressively difficult. This is a type of programmed learning which reflects the
concept of programmed instruction.
This technology first came to light after the publication of a paper in 1954 on “The science of learning
and the art of teaching” by the behavioral psychologist B.F. Skinner to improve teaching. He emphasized
that to learn a behavior, a student must engage in behavior. It is not enough to attract the student’s attention
but more important is that the attention of the student should be directed to what the teacher wants him to
learn. Reinforcement must be immediate and frequent because the knowledge that he is right is sufficient
enough to encourage him to learn more. A student learns better and is motivated to learn more if the steps
taken by him are confirmed to be correct immediately. Skinner pointed out that “holding students together
for instructional purpose in a class is probably the greatest source of insufficiency in education”.
In India research work in programmed learning started at National Council of Educational Research
and Training (NCERT) after nine years of Skinner’s publication. NCERT has delivered training to vari-
ous teachers from different disciplines in programmed instruction and developed some learning resourc-
es for the same. The Indian Association for Programmed learning was established in the year 1967 by
some persons highly interested in programmed learning. This association organizes annual conferences
on programmed learning and develops programs for different curriculum units. In nursing profession
in India programmed instruction as a teaching strategy is in the budding phase which requires lots of
nourishment of research evidences and teachers’ preparation in this technology.
27.1. Concept of Programmed Instruction

Programmed instruction typically consists of self-teaching with the aid of a specialized programmed
textbook or teaching machine that presents material structured in logical and empirically developed
sequences. It allows students to progress through a unit of study at their own rate, to check their own
answers and advancing only after answering correctly. The striking feature of programmed instruction
is that it can be tailored according to the level of the student; also, it provides immediate feedback to the
learner which encourages him to learn more and more.
According to J.A. Michael “programmed instruction is a method of instruction in which the informa-
tion to be taught is broken down into small units which are presented to the students usually in written
form in a carefully preplanned sequence. Each unit or frame contains not only information but is also
terminated with a question.”
According to Smith and Moore “programmed instruction is the process of arranging the material to
be leaned into a series of sequential steps. Usually it moves the student from a familiar background into
a complex and net set of concepts, principles and understanding.”
It is noteworthy that programmed learning must not be misconceptualized as merely a test which
consists of questions and answers, or an audiovisual aid, or a magic option for shortage of expert teach-
ers in nursing; rather, it is a teaching–learning strategy which has been proven superior to traditional
teaching–learning methods.
27.2. Salient Features of Programmed Learning

❑❑ Custom tailored instructions for individual students as per their level of understanding.
❑❑ Logically sequenced brief teaching material presented in small steps.
❑❑ Active learning as the learner has to interact with the program and has to follow the instructions/
commands provided by the system.
Chapter 07.indd 152 5/18/2012 11:44:33 AM

Principles of programmed
instruction
Mandatory principles Obligatory principles
1. Objective specification: the developer 1. Active responding: learner actively

of the programme should specifies responds to the commands or instruction.
the objectives in behavioral terms. 2. Immediate feedback: after answering
2. Empirical testing: The programme questions learner is provided immediate
must be tested empirically through the feedback which motivates the leaner to go
three phases ahead to learn more. This principle is
(a) Individual try out based on Skinner’s theory that if
(b) Small group try out reinforcement is provided immediately
(c) Field try out after the response it motivates the learner
to learn more. It also boost the confidence
Modifications in to the programme has to
of the learner.
be done as per the result of each phase.
3. Small steps: Units of the curriculum is
3. Self pacing: learner decides the pace to broken down in small units known as
which he has to work or learn with the frame, one frame is presented at a time to
programmed material. This principle the learner in logical sepuence.
incorporates the concepts of
individualized instruction.
Figure 7.2 Principles of Programmed Instruction
❑❑ Immediate feedback of the result which reinforces the learner to move ahead.
❑❑ As per the learners’ own pace, whether fast or slow; so it is meant for all students, whether bright
or dull.
❑❑ Proceeding from simple to difficult concepts in small segments.
A growing number of research studies throughout the world in various disciplines have suggested
that programmed instructions are much more superior to the traditional teaching methods, catering to
the need of the individual student. In nursing, this particular teaching strategy has not been given much
attention due to a number of reasons. Therefore, the need of the hour is that nurses much generate evi-
dences through research to support this technology in nursing education in India.
27.3. Principles of Programmed Instruction

F.U. Edward classified the principles of programmed learning in two categories in his book “Pro-
grammed Instruction: Techniques and Trends”. These principles are explained in Figure 7.2.
27.4. Styles or Types of Programming

Some of the important styles of programming are as follows.
❑❑ Linear programming.
❑❑ Branching programming.
Chapter 07.indd 153 5/18/2012 11:44:34 AM

❑❑ Mathetics.
❑❑ Computer-assisted instruction.
It is beyond the scope of this text book to describe these styles in detail. Interested learners may refer
the advanced books on programmed instruction.
27.4.1. Linear or Extrinsic Style of Programming

It was developed by Skinner and his associates (1954). This is popularly known as the Skinnerian style
of programming. The techniques associated with this style of programming are based on the principle
that the learner’s original response should be gradually altered or shaped until he meets some standard
of acceptable performance. This style of programming presents subject matter in small steps or frames.
Features of Linear Style of Programming

1. Linear arrangement.
2. Small steps.
3. Controlled and structural responses.
4. Active response.
5. Immediate feedback.
6. Self-paced.
7. Minimum errors: only 5% errors are permissible in linear programming.
8. Simple mechanism.
9. Skip-linear program.
27.4.2. Branching or Intrinsic Style of Programming

This type of programming was developed by Norman A. Crowder. It is a program which adapts to the
needs of the student without any help of an extrinsic device, such as a computer. A branching program
may be produced for use on a teaching machine or in a book format. The book format of branching style
of programming is known as a ‘scrambled text’ because the pages do not follow in a normal sequence.
Students are instructed to move on to different pages of the book according to the choice of answer they
selected; similarly, he has to press a button on the computer screen as per the choice of the answer. It
may be further categorized into forward and backward branching.
Features of Branching Program

1. Based on traditional tutorial method.
2. Individualized instruction.
3. Larger frame.
4. Multiple choice questions.
5. Freedom to choose path.
6. Alertness of learners.
7. Detection and correction of errors.
8. Development of discrimination and creativity.
9. Useful in concept learning.
10. Easier to develop frames.
Chapter 07.indd 154 5/18/2012 11:44:34 AM

28. C OMPUTER ASSISTED INSTRUCTION (CAI)/COMPUTER

A SSISTED LEARNING (CAL)
The use of computers in education started in the 1960s when they were known as teaching machines.
After a decade, in the year 1970, with the advent of microcomputers, the use of computers increased in
education. In educational settings the use of computers is referred by many terms, which are as follows
❑❑ Computer assisted instruction (CAI)/Computer aided instruction (CAI)/Computer assisted
learning (CAL).
❑❑ Computer based education (CBE) and Computer based instruction (CBI).
Computer based education and Computer based instruction are the broadest terms and can virtually
refer to any kind of computer use in educational settings. Computer assisted instruction or Computer
assisted learning is a narrower term and is commonly referred to use of computers for teaching–learning
activities such as simulation drill-and-practice, and tutorial.
CAI is a type of programmed instruction in which a computer is used to provide programmed instruc-
tional materials, questions and answers according to the pace of the student. It also provides immediate
feedback to the learner about his response to a question. Therefore, it is a self-learning technique which
involves interaction of the student with the computer. Computer-assisted instruction uses a range of AV
aids, e.g., pictures, audio-video clippings and graphics, which help in enhancing the learning process.
CAI programs can take many forms, e.g. tutorials, drill and practice, simulation and problem-solving
approaches to present curriculum content as well as test the students’ understanding by providing feed-
back to their response.
28.1. Historical Background of CAI

In the year 1966, the first general-purpose system for CAI was developed at the University of Illinois
at Urbana-Champaign by Donald Blitzer. It was known as PLATO (Programmed Logic for Automated
Teaching Operations) system. Later Control Data Corporation (CDC) took over the PLATO system.
In the year 1976, the first CAI classroom was set up at the Waterford Elementary School in Utah for
K-6 students. In the 21st century, the social software systems (Facebook, Orkut, Hi 5, and WAYAN) have
revolutionized the use of computer technology in classrooms by making communication high-tech and
cheaper, thereby enabling people to connect or collaborate through computers.
28.2. Salient Features of CAI/CAL

❑❑ CAI uses text or multimedia or combined content.
❑❑ Uses multiple-choice questions to pretest the knowledge as well as for posttest to assess learning.
❑❑ Provides simulated real-life problems.
❑❑ Provides immediate feedback to the learner which reinforces them.
❑❑ Records and analyzes the incorrect responses immediately.
❑❑ Summarizes learner’s performance at the end of the test.
❑❑ Provides repetitive drills to improve the participants’ knowledge.
❑❑ Provides game-based drills to increase learning enjoyment.
CAI can play an important role in the field of nursing education, nursing informatics and Tele-nursing.
Following are several examples.
Chapter 07.indd 155 5/18/2012 11:44:34 AM

Drill and practice. Drill and practice support from computers provide opportunities for students to
practice the skills repeatedly to achieve mastery on the subject. An example of this would be disaster
management drills and practices.
Tutorial. In tutorial, information is presented to the students. Based on that information, further dif-
ferent forms of work including drill and practice, games and simulation can be provided to the students.
An example of this would be educating college students about breast self-examination. By using a
tutorial and simulation students can learn about the techniques of breast self-examination and then test
themselves to see how much they remembered and how well they did it.
Simulation. Simulation software is an ingenious resource that can provide an approximation of real-
ity that does not require the expense of real life or its risks. This technique can be used to teach nursing
students about the basic life support, advanced cardiac life support, and how to handle disease outbreaks.
Problem solving. Problem-solving software teaches specific problem-solving skills and strategies.
The software presents multiple health scenarios from the database to the students asking them to solve
the problem. Thereafter, it provides feedback to them about their performance.
28.3. Research Studies on CAI/CAL

Research studies on CAI have generated lot of evidences to support the utility of CAI as a valuable
tool to improve teaching–learning. Following are some research facts in favor of CAI from researches
conducted in a variety of educational disciplines through the world.
❑❑ Students learn material faster with CAI than with conventional instruction alone.
❑❑ Students retain what they have learned better with CAI than with conventional instruction alone.
❑❑ Students are more interested in CAI than in traditional methods of teaching because of privacy
and readily available feedback provided by the machine.
❑❑ CBE produces higher achievement than conventional instruction alone.
❑❑ CAI is more beneficial with lower-achieving students than with higher-achieving ones.
❑❑ CAI is more effective for teaching lower-cognitive material than higher-cognitive material.
28.4. Pros of CAI/CAL

❑❑ CAI provides one-to-one interaction (individualized) with a student.
❑❑ It is particularly useful in those nursing subjects that require drill and simulation, e.g., emergency
nursing and disaster management.
❑❑ It provides privacy and individual attention to a particular student which is not possible in a class-
room by traditional teaching methods. Students are relieved of the embarrassment of giving an
incorrect answer in the classroom, thus helping the shy and slow learners to learn.
❑❑ It provides freedom for the students to experiment with different options.
❑❑ Provides immediate feedback to the answers elicited.
❑❑ Self-pacing—it allows students to proceed at their own pace whether slow or fast.
❑❑ Multimedia helps to understand difficult concepts through multiple sensory approach.
❑❑ Self-directed learning—students can decide when, where and what to learn.
Chapter 07.indd 156 5/18/2012 11:44:34 AM

28.5. Cons of CAI/CAL

There are drawbacks of the use of computers in instruction which are as follows:
❑❑ It may not be cost effective because of higher cost of the computer systems.
❑❑ Non availability of good CAI learning packages. Developing courseware by in-house efforts
rather than buying it can be expensive, time-consuming, and may require more programming
expertise than is available in the nursing field.
❑❑ If it is not used in conjunction with traditional instructions, it will limit the amount of human
interaction in the learning process and may result in mechanical learning.
❑❑ Use of CAI requires that individual student should have his personal computer, which may not be
possible in resource-limited countries like India.
❑❑ Health problems such as carpal-tunnel syndrome and eye disorders may occur due to excessive
use of the computer by the students.
Chapter 07.indd 157 5/18/2012 11:44:34 AM

CHAPTER HIGHLIGHTS
❑❑ Instructional strategies are those techniques of teaching used by teachers either in isolation or in
combination to facilitate learning.
❑❑ Lecture can be defined as a method of teaching in which a teacher delivers or presents preplanned
topics of interest through verbal communications or talking to the students in order to achieve
pre-specified teaching–learning objectives.
❑❑ Demonstration as a teaching method is the exhibition of a procedure with the explanation of every
step by the teacher in front of the students either in a lab or real-life setting to teach psychomotor
skills.
❑❑ Simulations are a useful teaching strategy for illustrating a complex and changing situation. Sim-
ulation is the imitation of some real thing, state of affairs, or process.
❑❑ In role play, a situation is staged by a group of students which plays roles of different characters
as required by the situation according to a prewritten script, under the direction of the teacher, for
deriving useful learning experiences. It is a useful method to teach attitude.
❑❑ Symposium is a series of speeches delivered by speakers to explore various aspects of a prob-
lem or issue in which each speaker contributes by presenting a particular aspect of the issue or
problem. In other words, it is a collection of opinions expressed or articles contributed by several
persons on a given subject or topic.
❑❑ Discussion is consideration of a question or problem in open and usually informal debate in which
every student is encouraged to put their views on the topic under consideration.
❑❑ A panel discussion is a type of discussion in which a group of panel members (experts of the field)
get together and discuss a given topic so that all the members can express their opinions regarding
the topic/problem under discussion.
❑❑ Seminar is a form of academic instruction, either at an academic institution or offered by a com-
mercial or professional organization.
❑❑ Workshop refers to educational seminar or series of meetings or a brief intensive course for a
small group. It emphasizes problem solving, interaction and exchange of information among a
small number of participants.
❑❑ Clinical teaching is the vehicle that provides students with the opportunity to translate basic theo-
retical knowledge into learning of a variety of intellectual and psychomotor skills needed to pro-
vide patient-centric quality nursing care.
❑❑ Bedside clinic is a method of clinical instruction for nursing students which is carried out in the
presence of the patient. Bedside clinic can be medical, nursing or combined (based on type of
topic).
❑❑ The aim of nursing rounds as a method of clinical teaching is to acquaint student nurses with all
patients in the ward so that better understanding and more purposeful care may be achieved for
each patient.
❑❑ Nursing reports are brief description of major clinical events, vital signs, diagnostic tests and nurs-
ing interventions related to a single patient or all the patients admitted in a ward.
❑❑ Individual conference is a student-centric teaching strategy in clinical area. It may be of two types:
planned and unplanned or incidental.
❑❑ Nursing-care plan is a learner-centric clinical teaching method which provides guidelines for
individualized patient care.
Chapter 07.indd 158 5/18/2012 11:44:34 AM

❑❑ Process recording is an exact written report of the conversation between the nurse and the patient
during therapeutic interaction.
❑❑ Lack of clear objectives and expectations, passive observation rather than active participation of
learners, inadequate supervision and provision of feedback are some common problems in clini-
cal teaching.
❑❑ The striking feature of problem-based learning is that it includes the principles of adult learning,
that is a sense of empowerment and “ownership” of their learning, that adults consider highly
valuable in their own education.
❑❑ Programmed instruction typically consists of self-teaching with the aid of a specialized pro-
grammed textbook or teaching machine that presents material structured in logical and empiri-
cally developed sequences.
❑❑ Some of the important styles of programming are linear programming, branching programming,
mathetics, CAI.
❑❑ CAI is a type of programmed instruction in which a computer is used to provide programmed
instructional material, and questions and answers according to the level of the student; it also
provides immediate feedback to the learner about their response to a question.
EVALUATE YOURSELF
Q 1: What are the characteristics of good description? (RGUHS 2010)
Q 2: Describe clinical methods of teaching with suitable examples. (BFUHS 2010)
Q 3: Describe the advantages and disadvantages of lecture method of teaching. (NIMS 2007)
Q 4: Define teaching. List various methods of teaching. Explain any two methods with advantages
and disadvantages of each. (RGUHS 2010)
Q 5: Discuss the advantages and disadvantages of the demonstration method. (NTRUHS 2010)
Q 6: Explain simulation as a method of teaching in nursing education. (BFUHS 2010)
Q 7: Describe principles of teaching. (MGU 2008)
Q 8: Write a plan of demonstration for B. Sc nursing II year students on oral care.
Q 9: Explain about field trip as a method of teaching for a group of students. (BFUHS 2009)
Q 10: Explain the role of the group leader in a group discussion. (RGUHS 2010)
Q 11: “Discussion” is one of the teaching methods in nursing education. List the different methods of
discussion and explain any two methods in detail. (MGRUHS 2009)
Q 12: Write short notes on the following.
❑❑ Nursing care study.
❑❑ Bedside clinic.
❑❑ Computer assisted leaning.
❑❑ Purposes of lecture method.
❑❑ Steps in developing a project.
❑❑ Lecture method.
❑❑ Panel discussion.
❑❑ Process recording.
Chapter 07.indd 159 5/18/2012 11:44:34 AM

❑❑ Nursing rounds.
❑❑ Project method.
❑❑ Role play.
Q 13: Differentiate between the following.

❑❑ Bedside clinic and nursing rounds.
❑❑ Seminar and symposium.
REFERENCES/ FURTHER READINGS

1. Rogers PL, Jacob H, Rashwan AS, Pinsky MR. Quantifying learning in medical students during
a critical care medicine elective: a comparison of three evaluation instruments. Crit Care Med.
2001;29:1268–73.
2. Morgan PJ, Cleave-Hogg D, McIlroy J, Devitt JH. A comparison of experiential and visual learning
of undergraduate medical students. Anesthesiology. 2002;96:2–25.
3. Gordon JA, Wilkerson W, Shaffer DW, Armstrong EG. Practicing medicine without risk: students’
and educators’ responses to high-fidelity patient simulation. Acad Med. 2001;75:469–72.
4. Eaves RH, Flagg AJ. The US Air Force pilot simulated medical unit: a teaching strategy with mul-
tiple applications. J Nurs Educ. 2001;40:110–5.
5. Issenberg SB, McGaghie WC, Hart IR et al. Simulation technology for health care professional
skills training and assessment. JAMA. 1999;282: 861–6.
6. Rauen C. Using simulation to teach critical thinking skills: you can’t just throw the book at them.
Crit Care Nurs Clin North Am. 2001;13:93–103.
7. DeAnda A, Gaba D. Role of experience in the response to simulated critical incidents. Anesth
Analg. 1991;72:308–15.
8. Morton PG. Using a critical care simulation laboratory to teach students. Crit Care Nurse. Decem-
ber 1997;17:66–9.
9. Crookall, D, and Oxford, RL (1990). Linking language learning and simulation/gaming. In D.
Crookall and R.L. Oxford (Eds.), Simulation, gaming and language learning (pp. 3–24). New York:
Newbury House Publishers.
10. Mahler SA, Wolcott CJ, Swoboda TK, Wang H, Arnold TC. Techniques for teaching electrocardio-
gram interpretation: self-directed learning is less effective than a workshop or lecture. Med Educ.
2011 Apr;45(4):347–53.
11. Beers GW. The effect of teaching method on objective test scores: problem-based learning versus
lecture. J Nurs Educ 2005 Jul;44(7):305–9.
12. Comer SK. Patient care simulations: role playing to enhance clinical understanding. nurse educ.
Perspective2005 nov–dec 26[6] .
13. Kilpatrick W (1918). “The Project Method.” Teachers College Record 19:319–35.
14. Fried-Booth D (1986). Project Work. Walton Street, Oxford: Oxford University Press.
15. Heide Spruck Wrigley. Knowledge in Action: The Promise of Project-Based Learning. Focus on
Basics. Volume 2, Issue D December 1998. Retrieved on 19/03/2011 from http://www.ncsall.
net/?id=384%20.
16. Bleeke MH (1968). The project: From a device for teaching to a principle of curriculum (Doctoral
dissertation, University of Wisconsin, Madison).
Chapter 07.indd 160 5/28/2012 2:16:21 PM

17. Knoll M. (1997). The project method: Its vocational education origin and international development.
Journal of Industrial Teacher Education, 34(3), 59–80. URL: http://scholar.lib.vt.edu/ejournals/
JITE/v34n3/Knoll.html.
18. Barrows HS. A taxonomy of problem-based learning methods. Med Educ 1989;20:481–6.
19. Neame RLB. How to construct a problem-based course. Medical Teacher 1981;3:94–9.
20. Smits PBA, Verbeek JHAM, de Buisonje CD. Problem-based learning in continuing medical edu-
cation: a review of controlled evaluation studies. BMJ 2002;324:153–6.
21. Colliver JA. Effectiveness of problem-based learning curricula: research and theory. Acad Med
2000;75:259–66.
22. Lewis D. Eigen, Research Paper Number 1, Report of the Center for Programmed Instruction, CPS,
New York, 1959.
23. Stuart Margulies and Lewis D. Eigen, Applied Programmed Instruction, John Wiley and Sons,
1961.
24. Cox K. Planning bedside teaching. (Parts 1 to 8.) Med J Australia 1993;158:280–2, 355–7, 417–8,
493–5, 571–2, 607–8, 789–90, and 159:64–5.
25. Parsell G, Bligh J. Recent perspectives on clinical teaching. Med Educ 2001;35:409–14.
26. Hargreaves DH, Southworth GW, Stanley P, Ward SJ. On-the-job learning for physicians. London:
Royal Society of Medicine, 1997.
Chapter 07.indd 161 5/18/2012 11:44:34 AM

c h a p t e r 8
Educational Media
1. INTRODUCTION
Audio-visual (AV) aids, or instructional aids, or audio-visual media, communication technology,
educational or instructional media, and learning resources are synonymous terms. Earlier, the
term used was audio-visual aids; with the advancement in the means of communication and that
of technology, educators coined these new terms. The use of newer terms “educational technol-
ogy” or “instructional technology” is primarily due to the dynamic expansion of programmed learn-
ing, computer assisted instruction (CAI) and educational television. Research effectiveness of AV
aids in teaching–learning has been researched extensively and findings suggest that learning is di-
rectly proportional to the number of senses which are stimulated with the help of AV aids during
teaching–learning process.
If I hear I forget, I see I remember, I do I learn

—Chinese proverb
Ninety percent of information going to the brain is through the eyes, eight percent of in-
formation is through the ears and two percent of information is through other senses.
This educational technology of AV aids evolved a century back when chalk with talk was the only visual
aid. The inventions of projectors, liquid crystal displays (LCD) and computer has revolutionized the use
of AV aids in educational setting.
Once writing is equal to ten times reading; once teaching is equal to ten times writings
—Unknown
2. DEFINITION OF AV AIDS
AV aids can be defined as stimulating material and devices which aid sound and sight in teaching to
facilitate learning of the students by activating more than one sensory channel. It helps to improve the
quality of teaching by making study material more interesting and concrete to the learners.
These are educational material which are used in classroom instruction, directed at the senses of
hearing as well as sight of the learner (films, recordings, photographs, etc.) to enhance learning by
increasing the attention span and interest of the learner.
Chapter 08.indd 162 5/18/2012 11:49:14 AM

Educational Media | 163
AV aids are “all material used in the classroom or in other teaching situations, to facilitate the
understanding of the written or spoken words”
—Dent
“Audio visual aids are those devices by the use of which communication of ideas between per-
sons and groups in various teaching and training situations is helped”
—Edgar Dale
“Audio visual aids are any device which can be used to make the learning experience more
concrete, more realistic and more dynamic”
—Kinder S. James
“Audio visual aids are those sensory objects or images which initiate or stimulate and reinforce
learning”
—Burton
3. PURPOSES OF AV AIDS
Use of AV aids serves some important purposes in teaching–learning process which are as follows.
❑❑ Clear images: clear images are formed when we see, hear, touch, taste and smell as our experi-
ences are direct, concrete and more or less permanent.
❑❑ Antidote to the disease of verbal instructions: they help to reduce verbalism. They help in giving
clear concepts, and thus help to bring accuracy in learning.
❑❑ Vicarious experience: it has always been seen that the first-hand experience is the best type of educa-
tive experience. However, sometimess it is neither practicable nor desirable to provide such experience
to pupils. Substituted experiences with the help of AV aids may be provided under such conditions.
❑❑ Variety: more chalk or talk does not help. AV aids give variety and provide different tools to the teacher.
❑❑ Retentive: they contribute to increase receptivity as they stimulate the response of the whole or-
ganism to the situation in which learning takes place.
❑❑ Based on maxims of teaching: it enables the teacher to follow the maxims of teaching like “con-
crete to abstract”, “known to unknown” and “learning by doing”.
❑❑ Helpful in attracting attention: it helps the teacher in providing proper environment for teaching
and learning.
❑❑ Conservation of energy and time: it saves a good deal of energy and time of both the teachers and
students as most of the concepts and phenomena can be easily classified, understood and assimi-
lated with the help of AV aids.
❑❑ Realism: it provides a touch of reality to the learning situation.
❑❑ Spread of education on a mass scale: it helps in providing opportunities for education to people
living in remote areas, and thus helpful in promoting adult education.
❑❑ Encouragement to healthy classroom interaction: it encourages healthy classroom interaction for
effective realization of teaching–learning objectives.
❑❑ Promotion of scientific temper: it helps the students to observe demonstration and phenomenon,
and thus cultivate scientific temper among them.
❑❑ Positive transfer of learning and training: it helps in the learning and solving of real-life problems
by making possible and appropriate positive transfer of learning.
Chapter 08.indd 163 5/18/2012 11:49:14 AM

❑❑ Reinforcement to learner: it proves effective reinforcement by increasing the probability of

re-occurrence of the response associated with them, and thus helps in the teaching–learning process.
❑❑ Best motivators: they are best motivators. The students work with more interest and zeal and are
more attentive.
4. PRINCIPLES OF AV AIDS
While using AV aids in the classroom, certain principles should be kept in mind to enhance its
effectiveness to facilitate learning.
❑❑ The teacher should be well prepared with the particular AV aid which he or she is supposed to use
with a particular lesson. For example, if a teacher is supposed to use transparency as an AV aid
then he should prepare it in advance, systematically arrange the transparencies in order and keep
it ready to use in the classroom.
❑❑ Check in advance whether the slide/LCD/filmstrip projector is available in the classroom and is
functioning.
❑❑ Make sure that technical support is available whenever required.
❑❑ Selection of the AV aid should be as per the requirement of the content to be presented to the students.
❑❑ Make sure that every student is able to see or hear the AV aid without any difficulty.
❑❑ AV aid should be prepared as per the prevailing guidelines for that particular aid and it should be
attractive enough to draw the students’ attention.
❑❑ As far as possible, students should be involved in preparation and preservation of AV aids.
❑❑ AV aid should be economical.
❑❑ Principle of stimulus variation and feedback reinforcement should also be considered while
preparing and selecting an AV aid.
5. KEY CONCEPTS IN THE SELECTION AND USE OF MEDIA

Selection and use of media or AV aids should not be a haphazard process; rather, it should be a sys-
tematically well-planned process so that, a suitable media for a particular group of students as per the
learning objectives can be selected and used.
The teacher should think judiciously while planning their lesson about the use of media. There are a
number of factors which should be considered simultaneously while making a selection for the appro-
priate AV aid. Some important factors which can guide a teacher through the process of selection and
use of media in education are as follows.
5.1. Learning Objectives

Learning objectives are the key areas which determine the suitability and applicability of a particular
AV aid. Select the AV aid from the all available options that can be helpful to deliver lesson contents to
achieve the desired learning objectives.
For example, if one presenting results of research findings they would have traditionally used radio
or television or chalk board. In this situation they would have to use PowerPoint slides to graphically
depict their findings as it will better serve the objectives. Therefore, objectives should not be tailored to
the media; rather, objectives should guide media utilization.
Chapter 08.indd 164 5/18/2012 11:49:14 AM

5.2. Size and Nature of the Group

The size of group is another important factor that influences selection of media. For example, for a small
size class of 10–30 students charts can be used effectively, but for a large group (50–100 students) charts
will not be visible to all students and, you will have to choose either transparency or PowerPoint slides
with an amplifier to augment your voice. Beside the size of group, a teacher has to consider the nature
of the audience, in terms of age, sex, socio-cultural background, motivation and the physical abilities or
disabilities, which have considerable impact in media selection.
It is better to know in advance the size of the group to whom you are planning to teach. If you are
teaching a group routinely then you may know its size advance, but the problem arises when you are
assigned to teach a class of external students. Communicate with the class coordinator and know the
number of students present in the assigned class.
5.3. Availability of Resources

Nursing colleges are resource-limited in India, hence nursing faculty has to explore the available re-
sources in the college while planning and preparing for instructional aids. In a resource-limited setting,
you cannot prepare and plan to use costly media. It is always better to choose an economical media
whenever possible.
5.4. Technical Support

If you are planning to use technically sophisticated media, then make sure that technical support is
available whenever required. It is better to avoid technically sophisticated media (film strip projector,
LCD projector, Data projector) if you are not well acquainted with the technology of that particular
media or when technical support is not readily available.
5.5. Know your Expertise in Preparation on Media

For example, after considering the factor listed earlier, you realize that transparency and PowerPoint
slides are two available options which can be used to teach a particular content to a group. Eavaluate
both options and choose the one on which you or your students can prepare the content more skillfully
and creatively. In some situations you may also consider commercially available AV aids.
5.6. Media Characteristics

During selection and use of media, preference should be given to those AV aids which can be stored and
retrieved, provided that the selected media is not compromising the learning objectives and students’
attention. Another media characteristic of significance is the physical qualities of the media, which in-
cludes the attributes, authenticity and significance of the content.
5.7. Electricity
Availability of electricity becomes an important consideration before selecting a media that requires the
use of electricity (e.g., transparency, LCD projector, etc.); therefore, you will have to ensure that there
is uninterrupted supply of electricity in the classroom or else have an alternative media ready to use in
case of electricity failure.
Chapter 08.indd 165 5/18/2012 11:49:14 AM

5.8. Learner’s Response

Media utilization should focus on learners’ response through discussion, project, dramatization, and so on.
5.9. Legal Consideration

Legal aspects should be considered in the production and the utilization of educational communication
media and this is particularly important where AV materials are prepared by the teacher. It is always
advisable to obtain permission in writing to avoid possible legal involvement.
5.10. Other Concepts

Stimulus variation, feedback, reinforcement and learner participation are some other concepts that
should be considered.
6. T EACHER’S ROLE IN PROCURING AND MANAGING

I NSTRUCTIONAL AIDS
The teacher has to play a key role in storage, borrowing, retrieval and monitoring of the use of AV aids.
At the college level, a nursing faculty can manage these aids in AV aids room which is an essential part
of a college of nursing as per Indian nursing council norms.
Models and charts can be permanently installed on the walls in the particular classroom in which
they are supposed to be used; for example, anatomical models charts can be placed in first-year class-
room. Similarly, models of pelvis and fetus can be placed in final-year B. Sc classroom.
Cheap Simple Improvised Up to date Accurate
Portable Motivates Large in

the learner size
Meaningful Purposeful
Creative
Good AV aid
Figure 8.1 Characteristics of Good AV Aid
Chapter 08.indd 166 5/18/2012 11:49:15 AM

Those AV aids which are fragile and costly should be kept under lock. TV, LCD projector and over-
head projector can be installed permanently in each classroom depending on the number of devices
available in a college.
The teacher has to involve the students in preparation of the AV aids. It will enhance their creativity;
imagination, critical thinking as well as help them learn the concerned study material while preparing
these teaching aids. The teacher should act as a guide and facilitator in the development and use of AV
aids by the students.
Evaluation of the AV education program should be made at regular intervals and budget appropriation
should be made regularly for the program.
AV aids can be borrowed or purchased from outside agencies, if available. The teacher has to be
knowledgeable about these agencies and departments. Some of the sources of AV aids are as follows.
❑❑ Educational agencies (NCERT).
❑❑ Professional organizations.
❑❑ Non-governmental organizations.
❑❑ Voluntary organizations.
❑❑ Commercial producers (Pearson Publication, Lippincott’s Ovid SP etc.).
7. TYPES OF AV AIDS
AV aids can be categorized into three broad categories, that is, audio aids, visual aids and audio-visual
aids. These categories can be further classified as listed in Table 8.1.
TABLE 8.1 Classification of Educational Media

Audio aids Visual aids Audio-visual aids
Non Projected Projected
❑❑ Radio ❑❑ Black/green board ❑❑ Films ❑❑ Television

❑❑ Gramophone ❑❑ Magnetic board ❑❑ Filmstrips ❑❑ Liquid Crystal
❑❑ Tape Recorder ❑❑ Bulletin board ❑❑ Slides Display
❑❑ CD/ Cassettes ❑❑ Flannel board ❑❑ Transparencies and ❑❑ Video
player ❑❑ Posters OHP ❑❑ LCD projector
❑❑ Public address ❑❑ Charts ❑❑ Data projector ❑❑ PowerPoint slides
system. ❑❑ Flash cards ❑❑ Computer
❑❑ Cartoons
❑❑ Flip-charts
Printed aid
❑❑ Leaflets
❑❑ Pamphlets
Three-dimensional aids
❑❑ Models
❑❑ Objects
❑❑ Specimens
❑❑ Dioramas
❑❑ Puppets
Chapter 08.indd 167 5/18/2012 11:49:15 AM

7.1. Visual Aids (Non-Projected)

7.1.1. Blackboard or Green Board
The blackboard or green board is the commonest and oldest visual aid used for teaching. It is so com-
monly used that it has become a compulsory part of a classroom. A blackboard can augment the lecture-
cum-discussion teaching method. It can serve as an effective visual aid if used properly and systemati-
cally. Guidelines for the effective use of blackboard in a classroom are as follows.
❑❑ Make sure that board is clean before starting the class; erase any material as it will distract the
students.
❑❑ Divide the board into two equal halves and start writing from the first half of the board; when it
is full, continue writing on the second half; when the second half of the board is full, then erase
the first half and so on (see Figure 8.2). This writing and erasing sequence will not interrupt the
students from taking notes from the blackboard.
❑❑ Write only the key points that make the skeleton of your lesson. Don’t overcrowd the board with
too much written content on it.
❑❑ Develop the concepts of your lesson on the board as you progress through your lesson.
❑❑ The size of the written letters on the blackboard should be large enough so that every student can
read it. Ensure their legibility from the last row before the lecture.
❑❑ Use white or yellow color chalk for writing on the board as other colors may not be clearly visible
to the back-row students.
❑❑ It is better to write in bold letters because thin letters are difficult to read.
❑❑ Use sufficient pressure while writing on board.
❑❑ Avoid writing on those areas of the board which may not be visible to all students, such as the
sides and the bottom of the board.
❑❑ Switch on the light above the board to ensure good visibility of the board. Avoid direct glare on
the board.
Figure 8.2 Proper Use of Blackboard
Chapter 08.indd 168 6/2/2012 9:57:30 AM

❑❑ Avoid speaking while writing on the board.

❑❑ Use colored chalks to highlight or differentiate.
❑❑ Stand clear of the written word.
❑❑ Don’t show your back for a prolonged time while writing on the blackboard.
❑❑ Clean it completely after the class is over.
Advantages of the Blackboard

1. Easy to use.
2. Electricity is not a necessity for its usage.
3. Cheap and readily available in most of the classrooms.
Disadvantages of the Blackboard

1. Requires good calligraphy skills to use it effectively.
2. The written material cannot be stored and reused.
3. If good quality chalk is not used it may make your clothes and hands dirty.
7.1.2. Flannel Board

A flannel board is simply a board covered with flannel which is a soft cloth that is made of cotton or
wool. Flannel board can be used as a visual aid as it facilitates placement of shapes, symbols, and cut-
outs on it. It helps the students in comprehension by its attractiveness and stimulating material presented
on it, also it brings out creativity and interest among students. It can serve as an effective visual aid for
smaller group of students.
The board is covered with felt or heavy flannel that will provide a background base for cutouts or
shapes. Black and light-blue colors are considered to be better for flannel board.
Cut-outs or shapes should be created with the material that can adhere to the board easily. Attaching
some pieces of sandpaper to the back of the cut-outs of paper will ensure good adherence to the board.
Students should be instructed to avoid glue while displaying cut-outs on the flannel board. A flannel
board provides an opportunity for original, colorful, eye-catching displays.
Advantages
1. Provides a scope for creativity and originality.
2. Students are more attracted and learn the content on the board with interest.
3. Contents of the board can be preserved for a long time and can be reused.
Disadvantages
1. It is time consuming to prepare the content to be displayed on the flannel board.
2. Materials have to be adapted to make it useful for flannel board.
7.1.3. Bulletin Board

It is the board on which current news, study material and quizzes etc., can be displayed by the students
(Figure 8.3). It is a visual aid which stimulates the students to prepare and display interesting learning
Chapter 08.indd 169 5/18/2012 11:49:15 AM

Figure 8.3 Bulletin Board
material for the class. It provides a unique teaching–learning experience to the students and results in
active learning as students are responsible for preparing and displaying the learning material on the
board. The teacher must delegate the responsibility to the head student to regularly check and maintain
the bulletin board. A teacher can also use it in a classroom to display illustration, steps of a process,
photographs, newspaper cuttings relevant to the lesson content and any other creative work to enhance
student learning.
Guidelines for Effective Use of Bulletin Board
❑❑ A bulletin board should be installed at a well-lit place.
❑❑ Neutral color should be used as background color of the bulletin board.
❑❑ It should not be over crowded, else it will lose its attractiveness.
❑❑ Items should be displayed creatively, systematically and logically which will create an appeal and
attract attention of the students.
❑❑ A suitable title should be given to each group of items placed on the board.
❑❑ Replace the items after a period of time with newer ones.
Advantages
❑❑ Cheap and effective visual aid, if used properly.
❑❑ Material displayed on the board can be stored in files and reused whenever required.
Chapter 08.indd 170 5/18/2012 11:49:17 AM

❑❑ Stimulates the student to search for or prepare creative work to display on board.
❑❑ Useful aid to display various announcements and classroom rules.
7.1.4. Flash Cards

Flash card, as the name indicates, is a card which is made of hard or compact paper of varying size on
which brief content or illustration is displayed. A series of cards are sequentially arranged and flashed
one by one for a few seconds in front of a small group of students to depict a concept or step of process
or list of clinical manifestations of a disease, which attracts the students’ attention and enriches their
learning experience.
The teacher should hold the card on the chest or use a folding case to show the card one by one to the
students while making sure that each student is able to see the card. The teacher should provide running
commentary of the content while showing the card. Ten to twelve cards for one talk can be used. The
messages on the card should be simple and brief line drawings or photographs, etc. In nursing educa-
tion flash cards are frequently used in the clinical setting during case presentation, drug presentation or
during planned health teaching. However, it can also be used in classroom teaching, provided that the
size of the group is small.
Advantages of Flash Cards
❑❑ Easy to prepare and use.
❑❑ Portable, so can be used whenever required.
❑❑ Effective aid to teach a complex process.
Disadvantages
❑❑ Cannot be used for larger group of students because the size of card is not large enough to be seen
by all students.
❑❑ Time consuming to prepare the cards.
7.1.5. Flip Chart

It is made of compact sheets or large pads of papers which may include picture maps, cartoons, hand-
made diagrams and photographs, etc. A flip chart is used as a visual aid in which information is provided
in sequence with the help of clipped compact sheets which are arranged in sequence, and each paper
sheet is flipped up after it has been shown to students.
7.1.6. Poster
Posters are a widely used visual aid to communicate messages to the mass. A poster should be dramatic
to attract attention of the target group with any prominent or central feature standing out sharply. You
might have seen posters of pulse polio program; can you recall what the message in that poster was?
Was it too long or too short? It was a short easily communicable message “do boond zindagi ki”. It is
noteworthy that many students wrongly consider poster and chart as synonyms. Posters are usually used
for communication with very large groups and the message on it is short and crisp while charts rae used
for small groups with slightly more content written in technically complex language on it.
A poster is usually prepared on a very large size tuff sheet and is displayed at a well-lit place where
most of the students or the target group can see it. A lot of creativity and imagination is required to prepare
a good poster. It is better to have a few trials before finalizing the layout of the poster. Background and
Chapter 08.indd 171 5/18/2012 11:49:17 AM

the color combination should be impressive and attractive with a clear and concise message written on
it. Jargons, technical and sophisticated words should be avoided in the message or text of the poster.
One picture is worth a thousand words: Chinese Proverb
Advantages
❑❑ Effective mean to communicate with large groups of people.
❑❑ Attracts attention of the audience.
❑❑ Does not require detailed study of the topic to prepare a good poster.
❑❑ Relatively cheap and easy to use.
Disadvantages
❑❑ It does not communicate enough information.
❑❑ May become ineffective when it becomes part of the routine environment.
❑❑ Time consuming and requires a lot of creative work and imagination to prepare a good poster.
7.1.7. Charts
Charts are an effective and simple visual aid frequently used by nursing students and teachers to explain
steps of a process, a concept or for comparison of two contrasting ideas that are too complex to explain
in words alone.
Similarly, a teacher can draw some pictorial on a chart to facilitate learning of a difficult concept.
The one difference between a chart and a poster is that while using the chart, the teacher has to explain
the content which is written or drawn on it in technical language; in contrast, in the poster the message
is clear and concise and self explanatory.
Guideline to Prepare Charts
❑❑ Select a good quality chart of appropriate size (20" × 30" or 30" × 40") and type (table chart, wall
chart, flow chart) as per the requirement.
❑❑ Give a clear and concise heading to the chart which describes what the chart is meant to depict.
For example, “Clinical manifestations of congestive heart failure”, “Pathophysiology of MI”. The
heading should be written in sufficiently large size letters that is eye-catching.
❑❑ Prepare a dark or light background as per your requirement and accordingly select the color of text
and other material which will be presented on the chart.
❑❑ Use imagination and creativity to provide good color combinations in the chart while depicting
contents or pictorial material. Contents should be arranged systematically.
❑❑ Do not use a number of different color shades unless it is a must.
❑❑ Enhance the esthetic look of the chart by systematically presenting information on it.
❑❑ Display the chart at a well-lit place and at appropriate height and distance from where students
can see it easily.
Advantages
❑❑ Easy to prepare and handle.
❑❑ It is portable, therefore can be used in any setting for a small group of students.
Chapter 08.indd 172 5/18/2012 11:49:17 AM

❑❑ It is not costly, hence can be used widely to explain comparison, process, and sequence of events.
❑❑ Can be reused when required.
❑❑ Easy to store.
Disadvantages
❑❑ Useful to teach only small group of students, not for large groups.
❑❑ May not attract students’ attention if it is not carefully planned, designed and is jumbled with
information.
7.1.8. Graphs
Graphs are visual aids that are most commonly used to present statistical data as well as the trends of certain
characteristics. Undergraduate and postgraduate nursing students use this aid to present their research find-
ings before research committees. There are certain types of graphs that can be used to depict a group of data.
Pie Graph
It is also known as circle diagram. The data are presented thorough the sections of a circle. The total
frequencies or value is equated to 360 degrees and then the angles for the corresponding components
are calculated. After determining their angle, the required sectors are drawn in the circle (Figure 8.4).
Bar Graph
Horizontal or vertical bars are used to represent the data in this type of graph. Before constructing bars,
scale is prepared according to the type of data, which determines the length of bars. Equal spacing is
necessary between two consecutive bars. There is a wide variety of types of bar graphs which you can
explore in Microsoft excel utility (Figure 8.5).
35% 40%
BSC
PB BSC
GNM
25%
Figure 8.4 Pie Chart Showing Percentage Distribution of Students in Various Nursing Programs in Punjab
Chapter 08.indd 173 5/18/2012 11:49:18 AM

OSA+ OSA-
82% 92%
18%
8%
CHF CONTROL
Figure 8.5 Bar Graph Representing Prevalence of Obstructed Sleep Apnea (OSA) in CHF Versus Control Group
Line Graph
Line graphs are used to show trends or relationship between two or more variables. Quantitative data
are plotted as dots in between horizontal and vertical axis and the dots are connected with a line which
makes a curve (Figure 8.6).
Pictorial Graph
In this type of graph pictures are used to express a given idea. They are more attractive and easily
understood.
92% N = 60
100% 80% 80% 75%
80%
52% 50%
Percentage 60% 46% 45% 42% 38%
of … 40%
20%
0%
.. ...
l.
..
a go tis or
s ed DS
l.
su rti ri
ry
s
n
is
I
ra
Vi hi ea
io
em
ge
os
Ve SA
stu
rt cr
ns
Tr
ur
or
e N
Po
te
A
es
op
D
er
ste
Ey
yp
O
Figure 8.6 Line Graph of Rank Order of First 10 Risk Factors of Fall Among Older Persons
Chapter 08.indd 174 5/18/2012 11:49:20 AM

Percentage distribution of students in various nursing

programmes
GNM
35% BSC
40%
PB BSC
25%
Figure 8.7 Doughnut Graph Showing Percentage of Students in Various Nursing Programs in Punjab
7.1.9. Cartoon
A cartoon is humorous caricature which gives an obvious message indirectly. It involves the features
of objects and people which are embroidered along with some general symbols. The drawing in a car-
toon should be simple and easily understandable. The symbols used should be familiar and represent a
concept or idea to which students can react intellectually.
7.2. Visual Aid (Three Dimensional)

7.2.1. Objects
An object is a three-dimensional visual aid. It is a sample of a real thing, which is visible and tangible
to the students. For example, a syringe, thermometer, Swan–Ganz catheter and stethoscope are objects.
The object can be used as a real visual teaching aid to explain the various parts or the structure and
its proper use. Students become excited and attentive when they see the sample of a real thing, which
leads to permanent learning about the focused instrument, item or material. Sometimes, it is difficult to
present the real object in the classroom because of some constraining factors, for example, the object
is costly, inaccessible and fragile. In this situation it is better to use a replica instead of the real object.
❑❑ Replica: It is the exact copy of the real object. The size, shape and feel of the replica are the same
as the real object. For example, fetus dummy, pelvis, skeleton system, etc.
❑❑ Facsimile: It is the same as a fax. It is the true copy or duplicate of the written or printed document.
7.2.2. Dioramas
A diorama is a three-dimensional arrangement of an object, like cut outs or models, to illustrate a central
idea, theme or concept. These objects and models are arranged in a show case which is like a big box
with a glass covering and background printed with a shade or a scene.
Chapter 08.indd 175 5/18/2012 11:49:21 AM

It is an effective AV aid to teach the appearance of actual things which are impossible to bring to the
class room. It also provides opportunity to show live things in the classroom, e.g., an aquarium. The
major disadvantage of dioramas is that it is costly to prepare and sometimes it may communicate false
information to the students if it is not a replica of the actual thing.
7.2.3. Specimen
A specimen is a three-dimensional visual aid which is most commonly used in teaching of anatomy,
zoology and botany. It is a representative of the whole thing. For example, a specimen of human lung
or heart is representative of all human lungs or hearts in terms of structure and function, hence can be
used for the study of the human lung or heart. Likewise, a handful of black gram or rice or wheat is
representative of their grain species and can be used for the study of the same.
Advantages
❑❑ Specimens provide first-hand information to the students, hence they are an effective visual aid
widely used in study of anatomy.
Disadvantages
❑❑ Very costly teaching aid as it requires organ donation to get a specimen in an anatomy lab.
❑❑ Difficult and costly to preserve and store the specimen.
7.2.4. Models
Models are three-dimensional (height, width and depth) visual aids which are not same in size, shape or
function of the real object. Although models are not the same in size and shape or other physical param-
eters to the real objects, still they imitate the real object, and hence can be used as effective visual aids.
Models are more creative and attractive, and therefore catch the eye of the students easily.
In nursing sciences models are most frequently used to teach the physical setup of an institution, for
example, water sanitation plant, hospital, cath lab etc., or to teach structures of various body organs, for
example, model of heart, lung, kidney etc., or to teach a procedure, for example, model of three-bottle
water-seal drainage system.
Advantages
❑❑ It is a useful visual aid for small as well as large group sizes.
❑❑ Models can be used to reduce very large objects and enlarge very small objects to a size that can
be conveniently observed by the students.
❑❑ It can be helpful to teach anatomy, nursing procedures and physical setup of various departments
in a hospital.
❑❑ Help to stimulate reality when it is not possible to access the real object or replica.
❑❑ Models are useful for demonstrating the interior structures of objects or systems with a clarity that
is often not possible with two-dimensional representations.
❑❑ Models can be stored and reused whenever required.
Disadvantages
❑❑ Can convey wrong information to the students if not prepared carefully.
❑❑ Costly and time consuming to prepare good models.
❑❑ Require a lot of space and caution to store the model.
Chapter 08.indd 176 5/18/2012 11:49:21 AM

7.2.5. Puppets
Puppets have been used as a visual aid for teaching in India and China for the last 4000 years. Puppets
are an inanimate object used in the art of puppetry, popularly known as “Kathputli” in India. It is a three-
dimensional AV aid usually made of wood but any other material can be also be used to prepare it. A
puppet enacts a particular character in a puppetry show, which can be planned to teach some principles,
attitude toward specific health-related issues like HIV/AIDS and contraception in specific communities.
History of nursing and changing trends in nursing education can also be taught with the use of puppets. It
requires a well-written script to make the teaching effective and interesting. Students learn by viewing the
performance of the puppets during the show as well as by making the puppets, and acting as puppeteers.
Puppets can be of various types; for example, hand/glove puppet, string puppet, rod puppet, shadow
puppet. String puppets are very popular in north-west part of India while rod and shadow puppets are
common in southern India.
Advantages
❑❑ Students learn by doing (making puppets, script writing, and organizing puppet shows).
❑❑ Puppets can be stored and reused.
❑❑ Puppet play provides the opportunity to the students to get comfortable in situations that are
unfamiliar or challenging.
Disadvantages
❑❑ Time consuming and difficult to make good puppets.
❑❑ Requires special training to become good puppeteers.
7.3. Visual Aid (Printed)

7.3.1. Leaflets
Printed material, which includes leaflets, pamphlets and magazines are the major means of conveying
propaganda. Leaflets were initially used in military settings to communicate a message rapidly among
soldiers. Once printed and delivered, it can be retained and readily passed from person to person without
distortion of information.
A leaflet is a written or pictorial message on a single sheet of paper that is printed on both sides and
folded in half, in thirds, or in fourths; however, it has no standard size, shape, or format. While select-
ing the size, shape and weight of the paper, the primary consideration is that the paper accommodates
the message and be easy to distribute. The most commonly recommended size of leaflet is 6″×3″. The
major factors which affect the leaflet sizes are the length of message, artwork required, and the purpose
of the leaflet. A properly developed and designed message on a leaflet can have a deep and lasting effect
on the learner, and hence it is commonly used as an effective AV aid in a teaching–learning situation.
Guidelines for Making Effective Leaflets
❑❑ The teacher must persuade the students with the reasonableness of the message so that the reader
will be motivated either to pass it on to others or to relay the message by word of mouth.
❑❑ The heading of the leaflet must be brief, summarizing the theme by using short and effective words.
❑❑ To gain the interest of a target audience within the first few words, the first sentence of the text
should contain the essence of the message.
❑❑ While using pictures in leaflets the picture and the text must complement each other.
Chapter 08.indd 177 5/18/2012 11:49:21 AM

Advantages
❑❑ A leaflet can be passed from student to student without distorting the information on it.
❑❑ It allows for the use of photographs and graphic illustrations which can be easily understood by
all level of students.
❑❑ It is permanent and can be stored and retrieved whenever required.
❑❑ It can be useful to communicate messages for a very large as well as small group of students.
❑❑ It reinforces learning by providing chances of rereading as and when required by the students.
Disadvantages
❑❑ Dissemination of the leaflet is time consuming and costly.
❑❑ It is less timely than other means of communication.
❑❑ It can be altered by overprinting.
❑❑ Development and design of effective printed material requires trained and knowledgeable
personnel.
7.3.2. Pamphlet
The pamphlet has been used for centuries as an economical AV aid for broad distribution of informa-
tion. A pamphlet is a booklet which is unbound or without a hard cover. It typically consists of a few
pages that are folded in half and saddle stapled at the crease to make a simple book. In order to count as
a pamphlet, UNESCO requires a publication to have at least 5 but not more than 48 pages, exclusive of
the cover pages; a longer item is a book.
Pamphlets can contain anything from information on emergency management of heart attack to the
steps of basic life support, warning signs of cancer and warning signs of stroke etc. It may also describe
particular drugs, steps of some emergency conditions which will help the students to learn by providing
them rapid access to the material as and when required.
7.4. Visual Aids (Projected)

7.4.1. Overhead Projector
Overhead projector (OHP) is one of the most frequently used visual aid in nursing education which has
replaced the blackboard in most of the classrooms. As the name indicates, it is a projecting device that
is made of a lamp, lens and mirror arrangement which projects material, which is written or drawn on a
transparent plastic sheet (transparency), on a screen (Figure 8.8).
The size of the plastic sheet is usually 25 × 20 cm. Although it is not a sophisticated instrument
like the data projector but it still requires some guidelines to be followed to make it an effective
teaching aid.
Guidelines for Overhead Projector

❑❑ Make sure that every student in the class can see the screen easily without any obstacle. The OHP
should be set up for optimum image size and focused before the class starts.
❑❑ The stage of OHP where the transparency is placed should be clean so that it will not obscure the
images of the transparency.
❑❑ Follow the general rule of one idea-one transparency.
Chapter 08.indd 178 5/18/2012 11:49:21 AM

❑❑ The transparency must be covered with a opaque sheet while putting it on the OHP stage then
progressively disclose one point at a time.
❑❑ While using a transparency don’t talk to the screen, but talk to the students and use a pointer on
the OHP stage to point out on the transparency.
❑❑ Be creative while preparing a transparency; for example, to build up a complex diagram three
or four transparencies can be used as overlays on the original transparency or you may employ
cutouts to build visuals in stages.
❑❑ Radiographs can be projected successfully with the overhead projector. For this purpose, the
classroom must be darkened.
❑❑ Switch off the projector light when you are not using the OHP because the bright screen will
distract the students and also it is not good for the health of the OHP (projector may overheat).
❑❑ Black, blue and green colors are considered good for transparency preparation. Avoid yellow,
orange and red (not projected well by OHP).
❑❑ Not necessary to write text content in running CAPITAL LETTERS.
❑❑ Write in legible letters.
❑❑ While preparing transparencies, follow the rule of seven or eight lines per transparency and seven
or eight words per line.
Advantages of the Transparency
❑❑ Transparencies can be prepared well in advance and can be stored and reused whenever required.
❑❑ Progressive disclosure of a transparency is helpful to gradually build up the concept under study.
MIRROR
ADJUSTMENT FOR FOCUS
TRANSPARENCY PLATEFORM
ON/OFF SWITCH
Figure 8.8 Overhead Projector
Chapter 08.indd 179 5/18/2012 11:49:21 AM

❑❑ Material can be prepared by the teachers themselves.

❑❑ It is a time-saving and cost-effective visual aid.
Disadvantages of the Transparency
❑❑ Novice teachers may feel difficulty in proper use of transparency.
❑❑ Creativity and imagination is required to make good transparency.
❑❑ Students may read on the transparency if the teacher exposed it entirely in the beginning, creating
disharmony in what the teacher is teaching and what the student is reading.
❑❑ Difficult to handle and preserve the transparency.
❑❑ Electricity is a must for its use.
❑❑ Teachers usually tend to talk to the screen instead of students.
❑❑ Inappropriate teacher’s position may cause difficulty in watching the transparency.
❑❑ Printed transparencies which teachers use because of lack of time to prepare a transparency cannot
be considered as good approach.
❑❑ Students require notes or handouts if class is taken with the help of transparency because most of
their time is spent in reading the transparency.
❑❑ Not useful for students with visual impairment and dyslexia.
7.4.2. Slides
A slide is a small piece of transparent material on which a single graphical image is placed or photo-
graphed. Slides are an important visual aid which is commonly used to provide high-quality images to
the learner with the help of a slide projector. It projects still images in sequence on the screen which
enriches the learning experience of the students. Slide projectors and filmstrip projectors are AV devices
which are used to project slides and filmstrips on the screen.
Slides are small-format photographic transparencies in color or black and white which are projected
with the help of slide projectors. On the other hand, filmstrip projectors project images contained in
filmstrips, which are a series of small slides photographed in permanent sequence on a 35mm or 16mm
film, either in color or in black and white.
Each film strip usually contains 12 to 18 films in a sequence. They are less expensive, easily handled
and can be stored for future use. They are adaptable for use in every subject area. There are two types
of slides which are as follows.
❑❑ Photographic slides: they may be black and white or colored. The size may vary between 2″ × 2″
and 3″ × 4″.
❑❑ Handmade slides: this type of slides can be made by using different types of materials (acetate
sheets, cellophane, etched glass etc.).
Advantages
❑❑ Attracts the attention of the students.
❑❑ Makes learning easy.
❑❑ It is a portable visual aid, can be used in variety of settings.
Disadvantages
❑❑ It is a costly visual aid.
❑❑ Handling of the slide and slide projector is difficult.
Chapter 08.indd 180 5/18/2012 11:49:21 AM

7.5. Audio Aids

7.5.1. Public Address System
Public address (PA) systems consist of a microphone or input source, a mixer amplifier and one or more
loudspeakers to convert electrical signals into sound. Simple PA systems of this type often provide 50 to
200 watts of power and are often used in small venues such as college auditoriums, lecture theater and
big classrooms to make teacher’s voice audible to the students. A sound source, such as a computer, may
be connected to a PA system so that audio or video can be played through the system.
PA systems with a larger number of speakers are widely used in institutional and commercial build-
ings, to read announcements or declare states of emergency. Intercom systems which are often used in
schools also have microphones in each room to send replies to the central office.
7.5.2. Radio
A radio is an auditory aid which is used to present teaching material in the form of voice only. Its
primary purpose is to entertain public but it can be exploited as a teaching aid. The broadcasting of radio
programs is done by “Akashwani” center, which reaches the public direct in their homes.
As a teaching aid it can supplement classroom teaching and may be useful in improving pronuncia-
tion and language of the students.
7.5.3. Tape Recorder

A tape recorder is a portable electronic device that can play pre-recorded sound as well as record the
sound on a magnetic tape. It provides functions to play, forward, rewind and pause a particular tape. It
can be used to teach verbal communication skills and counseling skills to the nursing students. Nowa-
days, CD and DVD players have replaced the traditional tape recorder, as they are more convenient and
have a large storing capacity on a single CD-ROM or DVD-ROM.
7.6. Audio Visual Aids

7.6.1. Multimedia
When two or more different types of media are used sequentially in a single instruction or for self-paced
learning package, the term multimedia is used. Using multimedia or multi-image, a large amount of
information can be passed across to students, and high interest can be created in students. Furthermore,
different media can be tailored towards different objectives outlined for the lesson.
7.6.2. LCD Projector

LCD projector is the latest technological innovation which has revolutionized the world of AV aids. It
is a versatile teaching aid (multimedia) which is useful in almost all educational disciplines. Content is
projected with the help of a LCD projector, which can project everything on the screen, whether it is still
or moving (Figure 8.9). With the help of a LCD projector, a teacher can use video, audio, PowerPoint
presentation, slide show, puppet show, films, motion pictures etc., as teaching aids. It has the capacity
to hold the student’s attention for a prolonged period of time if used correctly.
Advantages
❑❑ Attracts the attention of the students.
❑❑ Makes learning easy.
❑❑ Can use a variety of presentation modes.
Chapter 08.indd 181 5/18/2012 11:49:22 AM

LCD PROJECTOR MOUNTED ON THE ROOF OF THE CLASSROOM
Figure 8.9 LCD Projector
Disadvantages
❑❑ It is costly and sophisticated equipment.
❑❑ Requires careful handling.
❑❑ It is not a portable device.
7.6.3. PowerPoint Slides

PowerPoint is a utility of Microsoft office which can provide high quality, high-tech delivery of teach-
ing materials through the use of slides on a computer screen (Figure 8.10). Being a versatile AV aid it
can incorporate anything, like pictures, audio, video, animation, text, graphs etc. on the slides, thereby
increasing the student interest and attention through stimulus variation.
Guidelines to Make Effective PowerPoint Slides and Presentation
❑❑ Choose dark or light background of the slides as per your requirement. Select dark color font if
your background is light and vice versa.
❑❑ Choose an appropriate layout for each slide as per the requirement (comparison, picture, video,
audio layout slide).
❑❑ Projected text should be large enough so that everybody in the classroom can see it without any
difficulty. Ideally, headline font size should be 36–44 font size and rest of the text should be in
32–36 font size. It should never be less than 24 font size. Select Sans Serif font type as it is con-
sidered best for PowerPoint presentations. All CAPITALIZED letters are difficult to read and
should be avoided.
Chapter 08.indd 182 5/18/2012 11:49:22 AM

Figure 8.10 PowerPoint Slides
❑❑ Use images to emphasize a particular point or concept but it should never be used just to occupy
free space on the slide. Images must be relevant to the content of the slide, otherwise it may dis-
tract the students.
❑❑ Use simple animation whenever necessary, it is better to use it sparingly.
❑❑ Follow the rule of eight (eight lines in each slide, eight words in each line.)
Disadvantages
❑❑ It easily becomes a replacement for the presenter, not reinforcement.
❑❑ More chances of misuse; presenter may just read on from slides, spoiling the purpose of the AV aid.
❑❑ The teacher may dare to take a class without enough preparation by putting all the content mate-
rial on the slides and just reading from it in the classroom.
Advantages of PowerPoint
❑❑ Greater flexibility in selection of slides and illustration of teaching points.
❑❑ Picture quality can be improved and pictures can also be edited as per requirement.
❑❑ Safe, clean and minimal storage space required.
❑❑ Textual information can be copied and retrieved any time and can be converted into hard copy.
❑❑ Capable to provide maximum stimulus variation, e.g., photographs interspersed with models and
data, audio, video and animation etc.
❑❑ Cartoon slides or fun slides can serve an educational purpose as well as lighten the teaching–
learning environment.
Chapter 08.indd 183 5/18/2012 11:49:24 AM

❑❑ Maintain a high level of interest in the lesson.

❑❑ Promote greater student participation.
❑❑ Can be used at all levels of learning.
❑❑ It is time-intensive to create PowerPoint slides but it is an investment which can easily be updated
and reused once teaching and learning patterns develop.
7.6.4. Films
Films are AV aids which communicate through sound and sight simultaneously. It blends pictures, col-
ors, objects and graphs to suits its purpose. It may be fixed filmstrips or slides, and motion picture films.
Types of Films
There are many types of films which are available commercially but the following types are more fre-
quently used as teaching aids.
❑❑ Instructional films: it pertains to specific instructional subjects and the duration of a film is usually
10–20 minutes. Films division of government of India in cooperation with ministry of education
has produced many instructional films on different subjects.
❑❑ Documentary films: it presents actual truthful material in a cinematically interesting way.
❑❑ Discursive films: a topic or series of related topics are presented in a systematic, logical way
through this type of films.
❑❑ Drill films: useful to teach disaster drills to nursing students.
Advantages
❑❑ Direct the attention of the whole class to the screen and to the pictures and words on it.
❑❑ Can depict the situations which the teacher cannot present in the class room.
❑❑ It can be shown over and over again if required.
❑❑ Attracts high degree of attention of the students, and hence can teach a large content material in
short time.
❑❑ Motion pictures are able to communicate emotional experience and attitude.
Disadvantages
❑❑ Films are costly.
❑❑ Trained staff is needed which is generally not available.
❑❑ It is difficult to discuss important points during the projection of a film.
7.6.5. Television
Television is considered as the electronic blackboard of modern society as well as a medium of mass
communication. It activates the sense of hearing and vision, and hence results in better learning. It at-
tracts the students and creates interest and desire to learn among students.
Advancement in technology has changed the size and shape of television, refining its quality as an
educational media. Television can be used to show video, seminars, demonstrations and lectures from
an expert who is otherwise inaccessible in the classroom. Its use as an AV aid is versatile and is consid-
ered very important in nursing education. It is a boon for distance education as it broadcasts a number
of educational programs through satellite into the homes of students.
Chapter 08.indd 184 5/18/2012 11:49:24 AM

LCD
PROJECTOR
LCD TRANSPARENCY SCREEN

GREEN BOARD
Over Head Projector
Figure 8.11 Various AV Aids Arranged in a Classroom
Advantages
❑❑ Can be used for large group of students.
❑❑ Saves the time of teacher and is an economical device.
❑❑ Reduces teacher’s workload.
Disadvantages
❑❑ Requires electricity for operation.
❑❑ Requires maintenance as well as a suitable place for installation.
Chapter 08.indd 185 5/18/2012 11:49:25 AM

CHAPTER HIGHLIGHTS
❑❑ AV aids or instructional aids are those technologies of education which enhance the learning with
the aid of sound and sight in the teaching–learning process.
❑❑ AV aids can be defined as those stimulating material and devices which aid in teaching through
sound and sight to facilitate the learning of the students by activating more than one sensory channel.
❑❑ The purposes of AV aids are to increase the effectiveness of teaching, make the learning experienc-
es last longer and to make the teaching instructions standardized as learners with varying abilities
can receive the same message and their individual differences are catered through the use of media.
❑❑ While using AV aids in a classroom, certain principles should be kept in mind to enhance its
effectiveness to facilitate learning.
❑❑ Learning objectives, group size of students, availability of resources and technical support, media
characteristics and electricity are some important concepts which should be kept in mind while
selecting appropriate media.
❑❑ AV aids can be classified into three groups: audio aids, visual aids and audio-visual aids.
❑❑ The blackboard or green board is the commonest and oldest visual aid used for teaching.
❑❑ A flannel board is a board covered with flannel which is a soft cloth made of cotton or wool. Flan-
nel board can be used as a visual aid by placing shapes, symbols, and cutouts on it.
❑❑ OHP is a projecting device that is made of a lamp, lens and mirror arrangement, which projects
material written or drawn on a transparent plastic sheet (transparency), on the screen.
❑❑ While preparing transparencies follow the rule of seven or eight (seven or eight lines per transpar-
encies, seven or eight words per line).
❑❑ PowerPoint slides are a utility of Microsoft office which can provide high-quality, high-tech de-
livery of teaching material through the use of PowerPoint slides.
❑❑ Bulletin board is a board on which current news, study material and quizzes can be displayed by
the students.
❑❑ Flash cards as the name indicates are cards made of hard or compact paper of varying sizes on
which a brief content or illustration is displayed.
❑❑ Specimen is a three-dimensional visual aid which is most commonly used in teaching of anatomy,
zoology and botany.
❑❑ Models are three-dimensional visual aids which are not the same in size, shape or function of the
real object.
❑❑ Puppet is an inanimate object which is used in the art of puppetry, popularly known as “Kath-
putli”. It is a three-dimensional AV aid usually made of wood but any other material can be also
be used to prepare it.
❑❑ Chart is an effective and simple visual aid frequently used by nursing students and teachers to ex-
plain steps of a process, a concept, or for comparison of two contrasting ideas that are too complex
to be explained by words only.
❑❑ When two or more different types of media are used sequentially in a single instruction or for self-
paced learning package, the term multimedia is used.
❑❑ Printed material, which includes leaflets, pamphlets and magazines are major means of conveying
propaganda.
❑❑ The most commonly recommended size of leaflet is 6″ × 3″. The major factors which affect the
leaflet sizes are the length of message, artwork required, and the purpose of the leaflet.
Chapter 08.indd 186 5/18/2012 11:49:25 AM

❑❑ In order to count as a pamphlet, UNESCO requires a publication to have at least 5 but not more
than 48 pages, exclusive of the cover pages; a longer item is a book.
❑❑ Television is considered as the electronic blackboard of modern society. It activates the sense of
hearing and vision, and hence results in better learning.
EVALUATE YOURSELF
Q 1: Write a short note on puppets. (RGUHS 2010)
Q 2: Explain the importance of AV aids in nursing. Describe the principles of any two aids. (MGU 2009)
Q 3: Discuss how blackboard is an effective visual aid in teaching nursing. (NIMS 2009)
Q 4: Write a short note on three-dimensional AV aids. (BFUHS 2009)
Q 5: Enumerate the criteria for selection of AV aids. (RUHS 2010)
Q 6: Differentiate between chalk board and bulletin board. (MGU 2008)
Q 7: Explain the method for selection of media for public educational programs in a rural area.
(BFUHS 2008)
Q 8: Explain the principles of effective use of OHP. (BFUHS 2008)
Q 9: What do you mean by educational media? Explain in detail about AV aids.
Q 10: Write short notes on the following.
❑❑ Chalk board.
❑❑ Overhead projector.
❑❑ Flash cards.
❑❑ Poster.
❑❑ Uses of flannel board.
❑❑ Bulletin board.
❑❑ Projected teaching aids.
❑❑ Slide projector.
❑❑ LCD projector.
❑❑ Power of PowerPoint as AV aid.
❑❑ Types of film.
1. Farrow R. ABC of learning and teaching in medicine. Creating teaching materials. BMJ.
2003;326:921–3.
2. Cannon R, Newble D. A handbook for teachers in universities and colleges. London: Kogan.
3. Newble DI, Cannon R. A handbook for medical teachers. Dordrecht, Netharlands: Kluwer Academic.
4. Kemp JE, Dayton DK. Planning and producing instructional media. New York: Harper and Row.
5. Hartley J. Designing instructional text. London: Kogan.
6. Loretta E. Heidgerken’s “Teaching and Learning in Nursing Education” twelfth impression, 2003,
Konark publishers ltd, Delhi.
7. Francis M. Quinn’s “The principles and practice in nursing education”, third edition, 1997, Stanley
thrones publications ltd., United Kingdom.
Chapter 08.indd 187 5/28/2012 2:17:09 PM

c h a p t e r 9
Microteaching
1. INTRODUCTION
The quality of nursing education is a significant factor that directly or indirectly affects the quality of
health care. Nurse educators play key role in the development of the future nurse’s manpower resource.
This manpower is useless if it is not competent enough in performing those tasks in which they are
supposed to be competent. It is of great importance that nurse educators imparting these competencies
to the future generation should have the capability to perform their task (teaching) efficiently. For this
purpose, they need to acquire requisite teaching skills so that they can impart better quality of nursing
education to the future generation.
In this chapter, we focus on those competencies that are important for an efficient nurse-teacher and
how these competencies can be acquired through the process of microteaching.
2. ORIGIN OF MICROTEACHING
Before the introduction of microteaching practice in the 20th century, status of the teaching and teacher
training programmes was not satisfactory throughout the world. Research studies conducted by educa-
tionist during that time explored that:
❑❑ Most of teacher training programmes were lacking in specific training objectives to guide student-
teaching.
❑❑ The experts were having different opinions on the procedures that followed in various aspects of
teaching in training colleges.
❑❑ Practice teachings were not supervised properly; supervision was unplanned.
❑❑ Feedback to practice teaching was mainly subjective with respect to teacher training perfor-
mance.
The concept of microteaching came into existence first at Stanford University (USA) where an
experiment research study was conducted by Bush, Allen, McDonald Acheson et al. on the identifica-
tion of teaching skills. The researchers were interested in development of evaluation tools to measure
the attainment of teaching skills. During the same time period, another researcher Keath Acheson was
conducting a study on the usefulness of video tape recorder in the development of technical teaching
skills.
The study reported that video recorder can be used to record student–teacher interactions in the class-
room during microteaching session. At the end of the session, the video clip can be critically analyzed
by the supervisors to provide systematic and accurate feedback to the student-teacher. All the steps of
Chapter 09.indd 188 5/18/2012 11:49:41 AM

Microteaching | 189
microteaching technique Teach → Feedback → Replan → Reteach → Refeedback were formulated.

Microteaching term was coined for this method of developing teaching skills in 1963.
Since then, microteaching is being used with undue emphasis in almost all the teacher training pro-
grammes including nursing, i.e., B.Sc. Nursing, M.Sc. Nursing.
3. CONCEPT OF MICROTEACHING
Microteaching is a way to build up skills and confidence to experience a range of lecturing styles and
to learn and practice giving constructive feedback. It gives instructors an opportunity to safely put
themselves under the microscope of a small group audience but also to observe and comment on other
people’s performances.
It involves intensive practice of a skill under observation. Usually, practice is videotaped and then
reviewed with a mentor giving feedback. The practice can be in a real situation or more usually in an
artificial practice room. This is used extensively in training: e.g., presentation and interview skills. The
recording allows feedback to be given in relation to specific behaviors, and the student is able to see
what the mentor sees, also making the watching session more focused on individual characteristics.
It is much more comfortable and real in classroom situations, because it eliminates pressure resulting
from the length of the lecture, the scope and content of the matter to be conveyed, and the need to face
large number of students, some of whom may be inattentive or even hostile. The advantage is that it
provides skilled supervisors who can give support, lead the session in a proper direction, and share some
insights from the pedagogic sciences.
The duration of a microteaching session ranges from 20 to 30 minutes. The equipments required for
microteaching session are:
❑❑ TV/computer set
❑❑ Video recorder
❑❑ Camera
❑❑ Tapes for camera
❑❑ Blackboard/whiteboard
❑❑ Flip charts, charts
❑❑ Markers with different color
David. B. Young defines “Micro-teaching is a device which provides the novice and experienced
teacher alike new opportunities to improve teaching. It is a real teaching scaled down in time and size
of the class, 1–5 students for 5–20 minutes.”
Kuhn (1968) defines “Microteaching is an opportunity to experiment with new teaching techniques.
Rather than trying something new with a real class, microteaching can be a laboratory to experiment
and receive feedback, first.”
4. STEPS OF MICROTEACHING
The microteaching session involves certain steps that are as follows:
❑❑ Defining the skill: Particular teaching skill which is to be learned is explained to the teacher-
trainees by the teacher-trainer in terms of its purpose and various components of the skill with
suitable examples.
Chapter 09.indd 189 5/18/2012 11:49:41 AM

❑❑ Demonstrating the lesson: In simulated conditions, the teacher-trainer demonstrates the skill in
microteaching to the student-teacher.
❑❑ Planning the lesson: On the basis of the demonstrated skill, the teacher-trainee plans a short lesson
plan for his/her practice.
❑❑ Teaching the micro lesson: The student-teacher/teacher-trainee teaches the lesson to a small group
of students. His/Her teaching is observed and supervised by the supervisor and peers.
❑❑ Discussion on the lesson delivered: According to the observation of the microteaching, the super-
visor provides feedback to the teacher-trainee. The supervisor reinforces the instances of effective
use of the skill and draws particular attention to the points where the teacher-trainee could not do
well.
❑❑ Replanning the lesson: The teacher-trainee replans the lesson as per the feedback given by the
supervisor, in order to use the particular skill more effectively the next time.
❑❑ Reteaching the lesson: The replanned lesson is retaught to another comparable group of students.
❑❑ Rediscussion or refeedback: The supervisor observes the reteach lesson and gives refeedback to
the teacher-trainee with convincing arguments and reasons.
❑❑ Repeating the cycle: The “teach–reteach” cycle may be repeated several times till the desired level
of skill is achieved. The supervisor is to enable the teacher-trainee to perfect his performance in
the particular teaching skill.
5. MICROTEACHING CYCLE
There are six steps involved in a microteaching cycle. These steps are shown in Figure 9.1. There can
be variations as per requirement of the objectives of practice session.
Plan
Re-feedback Teach
Re-teach Feedback
Re-plan
Figure 9.1 Microteaching Cycle
Chapter 09.indd 190 5/18/2012 11:49:42 AM

Microteaching | 191
Plan: This is the first step of microteaching cycle. In this step, the teacher-trainee plans
a lesson on such a topic that allows him/her to exercise the desired teaching skills.
The topic is analyzed into different activities of the teacher and the pupils. The
activities of teacher-trainee and pupils are well planned logically where maximum
application of the components of a teaching skill is possible.
Teach: This step involves the delivery of the preplanned teaching. The teacher teaches
the class with specific focus to practice the desired teaching skills. He should
be confident and courageous enough to handle the situation arising in the class
effectively.
Feedback: Practice of microteaching is useless, if the teaching step is not followed by a strong
and nonjudgmental feedback by an expert teacher/supervisor or peers. Feedback is
provided to the teacher-trainee about his/her performance, which includes the points
of strength as well as weakness. It helps the teacher-trainee to put efforts to improve
upon his/her performance in the desired direction.
A feedback that is constructive, nonjudgmental, and based on observation is con-
sidered a good feedback. An example of a good feedback is “You made exces-
sive hand movement while talking, and it was distracting.” It is not appropriate to
provide feedback on the basis of judgments like “you were nervous and lacking in
confidence.” The feedback should also include suggestions for improvement wher-
ever possible; for example, “You made excessive hand movement while talking,
and it was distracting. Perhaps, it would be helpful for you to keep a hand in your
pocket.”
Replan: The teacher-trainee replans his/her teaching in the light of feedback provided by
supervisor incorporating the points of strength and weakness. While replanning the
lesson, the teacher-trainee can use the same topic or a fresh topic.
Reteach: The teacher-trainee has two options while delivering reteaching. He/She can deliver
the teaching to the same group of the students provided that the topic is changed or
to a different group of students if the topic remains the same. This change will be
helpful to remove boredom or monotony of the students. The teacher-trainee tries
to overcome the weakness of previous lesson and incorporates the suggestions pro-
vided by the supervisor.
Refeedback: Feedback is provided again in the same manner as in feedback step as the cycle of
microteaching continues until the desired competency in teaching skills is achieved
by the teacher-trainee.
6. PHASES OF MICROTEACHING: ROLE OF THE TEACHER-TRAINER

There are three phases of the microteaching which are as follows:
❑❑ Knowledge acquisition phase
❑❑ Skill acquisition phase
❑❑ Transfer phase of microteaching
Chapter 09.indd 191 5/18/2012 11:49:42 AM

6.1. Knowledge Acquisition Phase

In this phase, the teacher-trainee acquires knowledge about the teaching skill and its various compo-
nents through illustrations, elaboration, and discussion. The role of the teacher-trainer in this phase is to
demonstrate the teaching skill so that the teacher-trainee can concretely understand the aim and various
components of the desired teaching skill. It also helps the teacher-trainee to explore the conditions in
which the particular teaching skill proves to be useful in the teaching–learning process. The analysis
of the skill into components results into various types of behaviors which are to be practiced by the
teacher-trainee.
6.2. Skill Acquisition Phase

In this phase, the student-teacher plans a lesson for practicing the particular teaching skill about which
he/she has already attained knowledge and watched the demonstration by teacher-trainer. He/She de-
livers the content prepared with the use of the desired teaching skill and continues his/her efforts till
he/she attains mastery level in that particular skill. The feedback is provided by the supervisor for the
purpose of change in behavior of the teacher-trainee in the desired direction so that he/she can achieve
the mastery level of skill.
6.3. Transfer Phase

After attaining command and mastery over each of the teaching skills, the teacher-trainee integrates all
these skills acquired and transfers it to the actual classroom teaching.
7. ASSUMPTIONS OF MICROTEACHING
Assumptions are the statements that are taken as granted to be true without any scientific evidences. The
assumptions underlying the concepts of microteaching are as follows:
❑❑ Teaching is a complex process, but it can be broken down and analyzed or measured into simple
skills.
❑❑ Teaching skills can be practiced one by one to achieve mastery level under simplified and specific
situation.
❑❑ Appropriate feedback if systematically given proves very significant for obtaining mastery level
in each skill.
❑❑ When all skills have been mastered, they can be integrated for real classroom teaching.
❑❑ The skill training can be conveniently transferred from simulated teaching situation to actual
classroom teaching situation.
8. TEACHING SKILLS
As mentioned above, teaching per se is a complex skill, but it can be analyzed or disintegrated into
simple teaching activities performed by the teacher in the classroom. The purpose of all these teaching
activities is to promote learning among students. These activities may include illustrating with ex-
amples, explaining, questioning, writing on the blackboard, drawing figures, etc. These specific teach-
ing activities/behaviors which are observable, definable, and measurable can be developed through
Chapter 09.indd 192 5/18/2012 11:49:42 AM

Microteaching | 193
r igorous training. The teacher uses these skills to achieve predetermined and specified learning objec-
tives. Therefore, teaching consists of a number of interrelated teaching skills, which occur at different
stages of teaching.
B.K. Passi in his book Becoming Better Teacher; Micro-teaching Approach and Allen and Ryan at
Stanford University (USA) listed some of the important teaching skills that can be practiced by the
teacher-trainee to be an effective teacher.
❑❑ Introducing a lesson
❑❑ Using blackboard
❑❑ Achieving closure
❑❑ Writing instructional objectives
❑❑ Probing questioning
❑❑ Teacher silence and nonverbal cues
❑❑ Reinforcement
❑❑ Fluency in questioning
❑❑ Explaining
❑❑ Illustrating with examples
❑❑ Stimulus variation Increasing pupil participation
❑❑ Recognizing and attending behavior
❑❑ Handling answer by the students
9. IMPORTANT TEACHING SKILLS AND THEIR SPECIFICATIONS

Stimulus variation: Change in speech pattern, change in interaction style, body movements, ges-
tures, pausing, focusing, oral-visual switching.
Illustration with examples: Relevant and interesting examples, use of induction, deductive
approach.
Blackboard use: Neat and adequate with reference to content covered, legible.
Reinforcement:Accepting and using the idea of students, use of praise words, use of pleasant and
approving gestures and expressions, writing students’ response on the blackboard.
Explaining: Breaking down complex concepts into small and simple steps, continuity, clarity, rel-
evance to content using starting and concluding statements.
Classroom management: Clarity of direction, call students by names not by roll numbers, make
norms of classroom behavior, check inappropriate behavior immediately, keep students in the eye span
(discussed in detail in Chapter 6).
Probing questions: Putting the question into understandable language first, allowing time to think,
and asking answer by calling the name of the particular student.
Advantages of Microteaching
❑❑ Superior performance in classroom teaching achieved by the teacher-trainee.
❑❑ Real teaching: The teacher and pupils work together in a practice situation.
❑❑ Accomplishment of specific tasks: Tasks are the practice of instructional skills, the practice of
techniques of teaching, the mastery of certain curricular materials, or the demonstration of the
teaching method.
Chapter 09.indd 193 5/18/2012 11:49:42 AM

❑❑ Increased control of practice.

❑❑ Helps in solving some of the problems involved in student-teaching practice: As microteaching
focuses upon specific teaching skills, it enables the supervisor and the learner to approach the
job in the spirit of mastering the teaching model. The appraisal of the student-teaching becomes
more objective because the student-teacher himself/herself is involved in the appraisal of his/her
microlesson.
❑❑ Effective in modifying teaching behavior.
❑❑ Effective technique for transfer of general teaching competence to classroom teaching.
❑❑ Provides a good prelude to a macrolesson: It helps to build up confidence step by step, provides con-
tinuous reinforcement to the teacher-trainee’s performance, and improves his/her teaching behavior.
❑❑ Provides safe practice ground.
❑❑ Individualizes teacher training.
❑❑ Facilitates the development of teaching skills (e.g., reinforcement, probing questions, etc.)
❑❑ The student-teacher can easily focus his/her attention on clearly defined aspects of the behavior.
❑❑ The student-teacher can concentrate on some specific aspects of teaching–learning.
❑❑ The objectives of microteaching are specified in terms of behavioral outcomes.
❑❑ It is more manageable than classroom teaching as the number of persons involved and the dura-
tion of teaching time is less.
❑❑ It enables the student-teacher to view and hear his/her own performance and thus enables him/her
to make self-criticism.
Chapter 09.indd 194 5/18/2012 11:49:42 AM

Microteaching | 195
CHAPTER HIGHLIGHTS
❑❑ Microteaching is a technique of teacher training which has an important place in developing
teaching skills among the student-teachers.
❑❑ The cycle of microteaching involves the following steps: Plan → Teach → Feedback → Replan
→ Reteach → Refeedback. These steps are repeated till the student-teacher attains mastery in the
particular teaching skill.
❑❑ Appropriate and systematic use of feedback by the supervisor plays a key role for the student-
teacher in the acquisition and mastery of the particular teaching skill.
❑❑ Teaching per se is a complex process, but it can be broken down into simple teaching activities
that are known as teaching skills.
❑❑ Teaching skill is the set of acts or behaviors of the teacher, which facilitates learning.
❑❑ Teaching is an activity that is demonstrable, observable, and definable and can be developed
through proper training.
❑❑ Microteaching involves:
(i) A single skill for practice (e.g., reinforcement)
(ii) One concept of content for teaching based on the skill to be acquired
(iii) Group of 5 to 10 students
(iv) 5 to 10 minutes of time to practice teaching skill
❑❑ After the acquisition of the core teaching skills by the student-teacher, it is possible to integrate
them for effective teaching in actual classroom situations.
❑❑ Microteaching is effective in modifying teaching behavior.
EVALUATE YOURSELF
Q 1: The purpose of microteaching is
(a) to exercise teaching skills by the teacher trainee
(b) to cut short the time of routine class
(c) to teach a lesson to the students
(d) to introduce a new lesson to the class
Q 2: Microteaching is different from the traditional teaching because
(a) The time taken in microteaching is shorter as compared to traditional teaching
(b) Microteaching involves 5 to 10 students in the class
(c) Shorter topic is used to practice a particular teaching skill
Q 3: The concept of microteaching came into existence first at
(a) Stanford University
(b) Cambridge University
(c) Columbia University
(d) Nalanda University
Q 4: Stimulus variation is a teaching skill which means
(a) Change in speech pattern
(b) Change in interaction style
Chapter 09.indd 195 5/18/2012 11:49:42 AM

(c) Oral-visual switching

Q 5: Microteaching term was coined in which year?
(a) 1963
(b) 1964
(c) 1965
(d) 1966
Q 6: Define microteaching and explain the cycle of microteaching in detail?
Q 7: Explain any 10 teaching skills in detail?
Q 8: Prepare a microlesson plan on sign and symptoms of heart failure?
1. Kuhn W. (1968). Holding a monitor up to life: Microteaching. Music Educators Journal, 55(4),
49–53.
2. Politzer R. (1969). Microteaching: A new approach to teacher training and research. Hispania,
52(2), 244–248.
3. Vare J.W. (1993). “Co-constructing the zone: A neo-Vygotskian view of microteaching”, Retrieved
January 23, 2011, from http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERIC-
Servlet? accno=ED360285.
4. Grewal J.S., Singh R.P. A comparative study of the effects of standard MT with varied set of skills
upon general teaching competence and attitudes of pre-service secondary school teachers. In: Das
R.C., et.al. “Differential effectiveness of MT components”, New Delhi: NCERT, 1979.
5. Singh L.C. et al. (1987). “Micro-teaching – theory and practice,” Agra: Psychological Corporation..
6. Allen D.W. et al. (1969).“Micro-teaching – A description”, Stanford University Press.
7. Passi B.K. (1976). “Becoming better teachers”, Baroda: Centre for Advanced Study in Education,
M.S. University of Baroda.
8. Sharma N.L. (1984) “Micro-teaching: Integration of teaching skills in Sahitya Paricharya, Vinod
Pustak Mandir, Agra”.
9. Allen D.W., Ryan K.A. (1969). “Micro-teaching”, Reading, MA: Addison Wesley.
10. Vaidya N. (1970). “Micro-teaching: An experiment in teacher training”, The Polytechnic Teacher,
Technical Teacher, Technical Training Institute, Chandigarh.
Chapter 09.indd 196 5/18/2012 11:49:42 AM

c h a p t e r 10
Measurement and
Evaluation
“Anything not understood in more than one way is not understood at all.”
—Unknown
1. INTRODUCTION
Evaluation is an essential part of teaching learning process. In educational setting it is the process of judg-
ing the effectiveness of experience through careful and systemic appraisal. It is the most crucial although
most neglected part of nursing education as well as nursing care provided by nurses. It is the only way by
which a teacher can know how much successful his or her teaching was, what areas in teaching need im-
provement, etc. Similarly, a student can know at which position he or she stands in the crowd of students,
what are his or her learning difficulties and so on. Evaluation is also necessary to determine the extent to
which curriculum objectives have been realized or if there is need of any improvement.
Evaluation, measurement and assessment are three different terms which are used synonymously,
although the meanings of these terms are slightly different from each other.
2. CONCEPTS OF MEASUREMENT, ASSESSMENT AND EVALUATION

Measurement refers to the process by which physical specification (length, height, weight) of an object is
determined. It is the process of assigning a number to an attribute (or phenomenon) according to some set of
rules. It involves collection of quantitative data as well as comparison of a quantity with a standard unit. In an
educational setting it may involve the measurement of attitude, IQ, etc. Standardized tools and people who
are skilled in administering these tools are the prerequisites of the measurement. For instance, we require a
thermometer to measure temperature, BP instrument to measure blood pressure, pulseoxymeter to measure
oxygen saturation, etc. and at the same time we also require a physician or nurse to administer these tools
to gather data. The end result of measurement is the collection of data and nothing else. Measurement in the
context of learning objectives is the application of a standard scale or measuring device to an object, events, or
conditions according to practices accepted by those who are skilled in the use of the particular device or scale.
Assessment refers to a test which is conducted to check the progress of a student against some
predetermined learning objectives. It can be defined as the process of documenting knowledge, skills,
attitudes and beliefs of the students, usually in measurable terms.
Chapter 10.indd 197 5/18/2012 11:50:11 AM

Remember that all tests are assessment but all assessments are not tests. Sometimes a teacher may
require some tools for assessment, for instance, basic life-support (BLS) skill assessment checklist is a
tool used to assess the BLS skills of undergraduate nursing students. Therefore, assessment is the speci-
fied conditions by which the behavior laid down in an objective may be ascertained. Such specifications
are usually in the form of written descriptions.
Evaluation is perhaps the most frequently used but least frequently noticed term among nursing
faculties. It is not simply administering a test to the students, checking the answer sheets and announc-
ing the marks to them, but it is the process of systematically assessing the design, implementation and
impact of programs, policies or projects. It is the most powerful tool in the hands of teachers to enhance
learning. What remains in the heart of evaluation is the “value or quality judgment”; without using these
two core words, the term “evaluation” cannot be explained.
American Evaluation Association states “evaluation involves assessing the strengths and weaknesses
of programs, policies, personnel, products, and organizations to improve their effectiveness”.
Clara M. Brown defines evaluation as never ending cycle of formulating goals, measuring progress
towards them and determining new goals, which means objective quantitative evidence.
K Sudha R defines educational evaluations as a process of estimating and appraising the degree and
dimension of students’ achievements. Further, it is the process of estimating and appraising the profi-
ciency level of the particular educational practice which is being conducted.
From the above definitions it can be inferred that evaluation is systematic process to determine
worth, merit, and significance of something or someone (procedure, policy, curriculum, teaching meth-
ods, etc.) using criteria against a set of standards.
In conclusion, we measure height or weight, coolness or hotness; we assess teaching and learning,
and we evaluate results in terms of some set of criteria.
Philosophy of Evaluation
Some statements which depict the underlying philosophy of the evaluation are as follows.
❑❑ Each student should receive such education that most fully allows them to develop their potential.
❑❑ Students should contribute to the society and receive personal satisfaction in doing so.
❑❑ Fullest development of the individual requires recognition of his or her essential individuality
along with some rational appraisal by themselves and others.
❑❑ Composite assessment by a group of individuals is likely to be in error than assessment made by
a single person.
❑❑ Every form of appraisal will have critics, which results in change and improvement.
Purposes of Evaluation
The overall purpose of evaluation is to provide information to enable each student so that, he can
develop according to his potential within the framework of educational objectives.
❑❑ To provide feedback to the student about his or her strength and weakness requiring special
attention by him or her.
❑❑ To assess the progress of the student throughout the year.
❑❑ To determine whether a particular student is competent enough to be advanced to the next class.
❑❑ To ascertain whether teaching strategies are effective or not; whether there is a need to change the
teaching strategies.
Chapter 10.indd 198 5/18/2012 11:50:11 AM

Measurement and Evaluation | 199
❑❑ To improve the curriculum in the light of recent advances.

❑❑ To satisfy the requirements of university for a curriculum.
❑❑ To recommend the names of students, who are eligible for a degree, to the university.
❑❑ To report the progress of the student to the parents.
❑❑ To prevent the society from the quacks and those who are not competent professionals by block-
ing them from getting degrees/diplomas.
❑❑ To assess the non-scholastic domains of a student’s personality (interests, attitudes, values).
❑❑ For the purpose of research.
Bloom stated the following main purposes of evaluation.
❑❑ To predict the educational practices which a particular student/teacher can best participate in or
organize.
❑❑ To discover the extent of competence which the students have developed in initiating, organizing
and improving their day to day work and to diagnose their strengths and weaknesses with a view
to further guidance.
❑❑ At the end of the course to certify students’ degree of proficiency in a particular educational practice.
Purposes of evaluation in nursing education are as follows.
❑❑ To determine the level of knowledge and understanding of the students in their classes at various
times during the year or semester.
❑❑ To determine the level of the students’ clinical performance at various stages.
❑❑ To determine each student’s strengths and weaknesses and to suggest remedial measures that may
be needed.
❑❑ To encourage students’ learning by measuring their achievements and inform them of their
successes/failures.
❑❑ To help the students to become increasingly self-directing in their study.
❑❑ To provide the additional motivation of examinations that provide opportunities to practice criti-
cal thinking, the application of principles, etc.
❑❑ To estimate the effectiveness of teaching and learning techniques of subject content and
instructional media in reaching the goal of their course.
View Point
Can you imagine what will happen if someone is provided with UG/PG degrees in nursing with-
out proper and objective evaluation? In my view it will ultimately lead to compromised and poor
quality of nursing care because those students who are not competent enough to provide quality
nursing care will also get qualified to obtain degrees/licenses for nursing practice if the evaluation
system is poor. It will also ruin the nursing education because nursing teachers who are the product
of poor evaluation system will not have enough knowledge and teaching skills that are required to
be a competent teacher. It will further lead to production of nurses with poor knowledge and skills
as they are trained by these incompetent teachers. This vicious cycle of teacher and students will
ultimately cost the status and reputation of the nursing profession in the society. Therefore, valid,
reliable and objective evaluation is a critical component of the educational system.
Chapter 10.indd 199 5/18/2012 11:50:11 AM

3. PROCESS OF EVALUATION
Following are the steps that the process of evaluation follows.
❑❑ Determine the learning objectives which are supposed to be evaluated.
❑❑ Determine the type of learning objectives (cognitive, skill, and attitude).
❑❑ Develop valid and reliable tools to gather data related to the learning objectives.
❑❑ Tools for evaluation can be questionnaires containing essay type questions and SAQs or
MCQs, or it may be an observation checklist for the evaluation of the skills. Choosing a right
tool for a particular type of learning objectives is essential for the success of the evaluation.
❑❑ The tools must fulfill the requirements of validity and reliability.
❑❑ Determine the approach for test administration (oral or written test, skill performance, role play,
etc.).
❑❑ Finalize the settings where it will be appropriate to administer the test (classroom, clinical area,
laboratory etc.).
❑❑ Administer the test/tools.
❑❑ Collect data.
❑❑ Analyze the data.
❑❑ Make judgment regarding quality and worthiness of the program on the basis of the students’
scores on the test.
❑❑ Provide feedback to students.
❑❑ Revaluate whenever necessary.
4. PROBLEMS IN EVALUATION/MEASUREMENT
4.1. Lack of Time
Nursing faculty often makes complaints/excuses of lack of time for not evaluating the students regu-
larly. Lack of time may be a result of poor time management skills hence faculty must try to overcome
this barrier; still, if it is not manageable then they can hire external evaluators from outside to manage
the affairs so that, this core activity of the education will not be jeopardized. They must consider that
evaluation is as important as delivering lectures or demonstrating skills to the nursing students.
4.2. Lack of the Skills to Carry Out Evaluation

Some teachers may not be competent enough to plan and execute the evaluation schedule. These teach-
ers must be identified by the principal of the college and remedial actions, e.g., in-service education,
refresher courses, etc., can be planned for those who are in need.
4.3. Continuous Evaluation is not Cost Effective

Sometimes continuous comprehensive evaluation may not be cost effective. But it should not be a
reason to hamper the process of evaluation; remedies to manage the budgets should be explored and
employed.
Chapter 10.indd 200 5/18/2012 11:50:11 AM

4.4. We Already Know Everything Which an Evaluation Will Tell Us

This is a common misconception among the nursing faculty that they already know about the students
as they are routinely encountering the students, and hence there is no need to administer any kind of test
to assess the level of students, and it is merely wastage of time, money and material. This psychology
is totally wrong because nobody can know about how good a student is in his or her studies until an
objective, reliable test is conducted.
4.5. Problem of Workloads of the Teachers

Nursing faculty may be excessively burdened with teaching and non-teaching works; for instance, they
have to go to the clinical area for four hours daily thereafter they have to take 10–12 hour classes per
week, which means 2 classes per day; beside that they have to perform a lot of clerical works (maintain
class and clinical attendance registers, getting the students’ leave signed by the principal, planning time
table, clinical rotations, etc.) so it becomes very difficult to plan and implement this rigorous evaluation
strategy which includes setting of question papers, checking answer sheets and maintaining records of
internal assessment. That is a reason why the faculty avoids taking responsibility of internal assess-
ments. Education experts are required to give a thought on this issue to solve the problem.
4.6. Problem of Lack of Curriculum Guidelines for Internal Assessment

Most of the teachers are ignorant about the items that should be covered in internal evaluation. Some-
times curriculum may not have appropriate guidelines for the planning and implementation of internal
assessment, or there may be lack of guidelines regarding weightage of various internal assessment ac-
tivities. Some experts in the field of education suggest that following items should be covered in internal
assessment to make it comprehensive.
❑❑ Monthly tests.
❑❑ Unit tests.
❑❑ Assignments.
❑❑ Case presentations, planned health teachings.
❑❑ Participation in declamation, debate and related contests.
4.7. Lack of Uniform Standards of Evaluation

Lack of uniform standards will cause inconsistency in the evaluation process that may lead to frustration
among students. Given below are some examples of inconsistency in evaluation.
❑❑ Some teachers will allow retakes of tests and quizzes, others do not.
❑❑ Different policies exist for work turned in late.
❑❑ The validity and reliability of student assessments vary.
❑❑ There are major philosophical differences regarding evaluation. Some teachers view learning as
primarily a student responsibility, while some place the responsibility for teaching mainly on
themselves.
❑❑ There is little agreement on how many assessments and what kinds are needed for evaluation.
❑❑ Even within the same school different teachers teach differently and test differently for the same
course.
Chapter 10.indd 201 5/18/2012 11:50:11 AM

5. PRINCIPLES OF EVALUATION
Following are the principles of evaluation which must be observed to make it an effective educational
exercise.
❑❑ Principle of learning objectives: this principle reflects the importance of learning experiences in the
process of evaluation. Ideally, the evaluation should be based on learning objectives of the curriculum.
❑❑ Principle of continuity: principle of continuity emphasizes that evaluation should be a continu-
ous activity throughout the academic session. Data collected over the extended period of time are
more reliable and valid indicator of a student’s performance rather than a one-day test. Therefore,
students should be subjected to evaluation every day.
❑❑ Principle of comprehensiveness: evaluation should be as comprehensive as possible and involve
scholastic as well as non-scholastic achievements of the students (e.g., punctuality, honesty, per-
sonality). One of the reasons for the slow progress of the nursing profession in India is attributed
to less focus on the non-scholastic part of achievement during evaluation, which shapes the over-
all personality of the nursing professional.
❑❑ Reliable and valid tools: tools used in evaluation play a key role in the effectiveness of evaluation.
If the evaluation tools are lacking in reliability and validity, it will not produce authentic data of
students’ performance. Essay type questions in particular are poor in reliability and validity, and
hence a lot of effort is required while framing essay types questions so that errors can be reduced
in evaluation.
❑❑ Variety: principle of variety emphasizes the use of multiple techniques in evaluation. For instance
evaluation should involve variety of tests as per the different types of learning objectives.
6. TYPES OF EVALUATION
Evaluation is a judgmental process and as such it reflects the belief, value and attitude of the participant
or student. Evaluation is divided into two categories, which are as follows.
❑❑ Formative assessment or evaluation.
❑❑ Summative assessment or evaluation.
The term assessment is generally used to refer to all activities teachers use to help students to learn
and to gauge student progress.
Michael Scriven (1967) coined the terms formative and summative evaluation and emphasized their
differences both in terms of the goals of the information they seek and how the information is used. It is
assessment of learning versus assessment for learning.
The concept of formative and summative assessment can be explained by using the example of day-
to-day life “when the wife tastes the soup in kitchen while preparing, it is called formative; when the
husband tastes the soup and says wow! What a great soup! That’s summative evaluation.”
Formative and summative assessments are two different types of evaluation approaches. Let us dis-
cuss one by one.
6.1. Formative Assessment

Formative assessment has a long history. It has evolved as a means to adapt to student needs. It is more
or less a reflective process that intends to promote students’ attainment.
Chapter 10.indd 202 5/18/2012 11:50:11 AM

Cowie and Bell defined it as the bidirectional process between teacher and student to enhance, rec-
ognize and respond to the learning.
Black and Wiliam consider an assessment “formative” when the feedback from learning activities is
actually used to adapt the teaching to meet the learner’s needs. Evaluation done to improve or change a
program while it is in progress is termed as “formative evaluation”.
According to Ministry of Education, New Zealand (1994) summative assessment refers to a range
of formal and informal assessment procedures (for example, the monitoring of children’s writing de-
velopment, anecdotal records, and observations) undertaken by teachers in the classroom as an in-
tegral part of the normal teaching and learning process in order to modify and enhance learning and
understanding.
Bronwen, Cowie and BeverleyBell (1999) defined it as “the process used by teachers and students
to recognize and respond to student learning in order to enhance that learning, during the teaching.”
Black and Wiliam (1998)—“Assessment refers to all those activities undertaken by teachers, and by
the students in assessing themselves, which provide information to be used as feedback to modify the
teaching and learning activities in which they are engaged. Such assessment becomes ‘formative assess-
ment’ when the evidence is actually used to adapt the teaching to meet the needs.”
Formative assessment is the continuous comprehensive assessment of the student throughout the
year. It includes assignments, class tests, unit tests, midterm examinations, clinical case presentations
and drug presentations, which may be conducted weekly or fortnightly. Similarly, after teaching a unit
of curriculum, the teacher should plan a test to evaluate whether the objectives of that unit are realized
or not. By doing so, the teacher can identify the students’ learning problems; effectiveness of his or her
teaching as well as provide immediate feedback to the students about their progress. It also acts as a
means of reinforcement to the students because when the students know that they are doing a very good
job it motivates them to learn better.
Benjamin Bloom, Thomas Hasting and George Madaus (1971) authored a book “Handbook of
Formative and Summative Evaluation”. In this book they argued that to reduce variation in students’
achievement and to have all students learn well, variation in instructional approaches and learning
time should be increased. The key element in this effort was well constructed, formative classroom
assessments.
Bloom outlined a specific strategy for using formative classroom assessments to guide teachers in
differentiating their instruction and labeled it “mastery learning.” He viewed formative assessment
as the keystone of “Learning for Mastery” (explained in detail in the next section). Every individual
student has their own learning style which may not be compatible with less varied teaching strate-
gies. Therefore, teachers should use their classroom assessments as learning tools, and follow those
assessments with a feedback and corrective procedure. In other words, instead of using assessments
only as evaluation devices that mark the end of each unit, use them as part of the instructional pro-
cess to diagnose individual learning difficulties (feedback) and to prescribe remediation procedures
(correctives).
This is precisely what takes place when an excellent tutor works with an individual student. If the
student makes an error, the tutor first points out the error (feedback), and then follows up with further
explanation and clarification (correctives) to ensure the student’s understanding. Similarly, academi-
cally successful students typically follow up the mistakes they make on quizzes and assessments. They
ask the teacher about the items they missed, look up the answer in the textbook or other resources, or
rework the problem or task so that errors are not repeated.
Chapter 10.indd 203 5/18/2012 11:50:11 AM

Research Highlights on Formative Assessment

Royce Sadler (1989) identified three elements that are crucial to the effectiveness of formative
assessment, which are as follows.
❑❑ Helping students to recognize clearly the desired goal (understand what is required).
❑❑ Providing students with evidence about how well their work matches that goal.
❑❑ Explaining ways to close the gap between the goal and their current performance.
Self-assessment is a vital component in learning. Feedback on assessment cannot be effective un-
less students accept that their work can be improved and identify important aspects of their work
that they wish to improve. Self-monitoring is a key component of the work of all professionals,
so if we want our students to become professional learners and professionals in their fields we
should actively promote self-assessment. If students are asked and encouraged to critically ex-
amine and comment on their own work, assessment can become more dialogue than monologue,
and can contribute powerfully to the educational development of students. As Wynne Harlen and
Mary James (1996) put it, marks or grades alone produce no learning gains. Indeed, there is some
evidence that students gain the most learning value from assessment when feedback is provided
without marks or grades. Where marks are provided, they often seem to predominate in students’
thinking, and to be seen as the real purpose of the assessment.
Five points summarize the key lessons from research about formative assessment. Assessment
that promotes learning
❑❑ involves learning goals understood and shared by both teachers and students;
❑❑ helps students to understand and recognize the desired standards;
❑❑ involves students in self-assessment;
❑❑ provides feedback which helps students to recognize next steps and how to take them;
❑❑ builds confidence that students can improve their work.
6.1.1. Bloom’s Mastery Learning

Benjamin Bloom outlined a specific instructional strategy known as “mastery learning”. This strategy
emphasizes that teachers should first organize the concepts and skills they want students to learn into
instructional units that typically involve about a week or two of instructional time. Following initial
instruction on the unit, teachers administer a brief “formative” assessment based on the unit’s learning
goals. Instead of signifying the end of the unit, this formative assessment’s purpose is to give students
information, or feedback, on their learning. It helps students identify what they have learned well to that
point and what they need to learn better (Bloom, Hastings, and Madaus, 1971).
Paired with each formative assessment are specific “corrective” activities for students to use in cor-
recting their learning difficulties. With the feedback and corrective information gained from a forma-
tive assessment, each student has a detailed prescription of what more needs to be done to master the
concepts or skills from the unit. When students complete their corrective activities after a class period
or two, Bloom recommended a second formative assessment which covers the same concepts and skills
as the first, but is composed of slightly different problems or questions.
Formative assessments are part of instruction designed to provide crucial feedback for teachers and
students. Assessment results inform the teacher of what has been taught well and not so well. They inform
Chapter 10.indd 204 5/18/2012 11:50:11 AM

students of what they have learned well and not learned so well. As opposed to a summative assessment
designed to make judgments about student performance and produce grades, the role of a formative assess-
ment is to improve learning. As opposed to benchmark tests that are used to predict student performance on
other tests (most often state assessments), formative assessments are intimately connected to instruction.
Formative Assessments are

❑❑ To enhance learning—the purpose of formative assessment is to enhance learning not to allocate
grades, whereas summative assessments are designed to allocate grades.
❑❑ Part of instruction—formative assessments are considered as a part of instruction and the in-
structional sequence. What students are taught is reflected in their assessment.
Formative Assessments Produce

❑❑ Non-threatening results—the purpose of formative assessment is to identify students’ learning
difficulties and to take remedial actions to rectify them. Its results are non-threatening as the stu-
dents are not labeled as pass or fail.
❑❑ Immediate feedback—results of formative assessments are produced “on the spot;” teachers and
students get them immediately. Teachers get a view of both individual and class performances
while students learn how well they have done.
❑❑ Structured information—teachers can judge success and plan improvements based on the for-
mative results. Students can see progress and experience success. Both teachers and students learn
from the assessment results.
❑❑ Ways to improve—summarized formative results provide a basis for the teacher to re-visit topics
in the unit if necessary. Individual student responses provide a basis for giving students additional
experiences in areas where they performed less well.
Classroom formative assessments occur while content is being taught and learned, and should con-
tinue throughout the period of learning and are not meant to assign grades; thus, its primary objective
is to inform the teacher of what his or her students know or do not know. More importantly, classroom
formative assessments allow teachers to make decisions and monitor their instruction based on student
performance.
Black and Wiliam’s (1998) reviewed more than 250 studies on formative and summative assessment
and concluded that formative assessments, as opposed to summative ones, produce a more powerful effect
on student learning. Terrance Crooks (1988) also reviewed research reports and reported that effect sizes
for summative assessments are consistently lower than effect sizes for formative assessments. In short, it
is formative assessment that has a strong research base supporting its impact on learning (Marzano, 2006).
6.2. Characteristics of Formative Assessment

❑❑ Small units are selected for assessment as soon as the teacher finishes his teaching and students
are asked for a unit test.
❑❑ It includes items at each of behavioral level specified.
❑❑ It helps the students to master each unit in particular and curriculum in general.
❑❑ It provides the teachers a platform to evaluate the students comprehensively throughout the
year which is a more reliable indicator of a student’s performance as compared to summative
assessment.
Chapter 10.indd 205 5/18/2012 11:50:11 AM

❑❑ Results of the formative assessment can be effective in reinforcing to the students if they achieve
mastery or near mastery level in each unit of learning.
❑❑ Works as effective motivators as the marks are immediately shown to students after the result.
❑❑ It helps the teachers in identifying the difficulties of the students, and modify their teaching strate-
gies to overcome learning difficulties faced by students.
6.3. Merits of Formative Assessments (Boston, 2002)

For Teachers
❑❑ Teachers are able to determine what standards the students have achieved and up to what degree.
❑❑ Teachers can decide the requirements of minor modifications or major changes in instruction so
that all students can succeed in upcoming instruction and on subsequent assessments.
❑❑ Teachers can create appropriate lessons and activities for groups of learners or individual students.
❑❑ Teachers can inform students about their current progress in order to help them in goal setting for
improvement.
For Students
❑❑ Students are more motivated to learn.
❑❑ Students take responsibility for their own learning.
❑❑ Students can become users of assessment alongside the teacher.
❑❑ Students learn valuable lifelong skills such as self-evaluation, self-assessment, and goal setting.
❑❑ Student achievement can improve from 21–41 percentile points.
7. SUMMATIVE ASSESSMENT
Summative assessment refers to the evaluation of the students at the end of the session or term for the
purpose of certification, grading or placement of the students. When evaluation focuses on the results
or outcomes of a program it is called summative evaluation. It involves the whole syllabus of the study
rather than a particular unit and includes a mark or grade against an expected standard.
The purpose of summative evaluation is to assess the overall achievements of the students and to
judge whether a particular student has learned enough to be promoted in the next class or is eligible for
the degree/diploma as per the predetermined criteria of evaluation. It should not be oppressive as well
as reactive as far as possible.
Bloom further classified the summative assessment in to two types, which are as follows.
❑❑ Intermediate summative evaluation: concerned with less generalized, less transferable and more
direct outcomes.
❑❑ Long-term summative evaluation: refers to the evaluation of the entire range of the outcomes that
a student is supposed to learn.
7.1. Characteristics of Summative Assessment

❑❑ It is the procedure to grade students’ level of learning in predefined period of time.
❑❑ It provides descriptive analysis of the students’ performance.
Chapter 10.indd 206 5/18/2012 11:50:11 AM

TABLE 10.1 Difference Between Formative and Summative Evaluation

Characteristics Formative Summative
Purpose To monitor progress of student To check final status of student
by getting feedback
Content Focus Detailed General
Narrow scope Broad scope
Methods Daily assignment Tests
Observation Projects
Frequency Daily Weekly,
Quarterly, etc.
❑❑ It is not oppressive and non-reactive as far as possible.

❑❑ It is positive, tending to emphasize what students can do rather than what they cannot.
❑❑ It is concerned with broad range of educational issues.
8. I NTERNAL ASSESSMENT AND EXTERNAL EXAMINATION:

A DVANTAGES AND DISADVANTAGES
Internal and external examinations are two important evaluation strategies for the overall assessment of
the student in an academic year.
8.1. External Examination

The process of external examination involves the external components in terms of question paper, viva
voce, examiner and checking of answer sheets. The question papers of examination are prepared by
external panel of university experts; viva voice and practical are conducted by external examiners ap-
pointed by the university. External examinations are usually planned for summative assessment for a
final decision. There are some advantages and disadvantages of this approach of examination.
8.1.1. Advantages
❑❑ It ensures uniformity of evaluation for all students under a particular university or board of
examination.
❑❑ It strives to ensure objectivity in the examination system.
❑❑ It reduces chances of biasness that may occur if examinations are planned and executed by inter-
nal teachers only.
8.1.2. Disadvantages
❑❑ It takes a lot of time to plan and implement external examination.
❑❑ It requires the need of appointing external examiners.
❑❑ External examiners cannot evaluate students’ comprehensively in a three-hour practical test.
❑❑ It is time consuming for the external examiners as they require traveling to and fro to conduct exam.
Chapter 10.indd 207 5/18/2012 11:50:11 AM

9. INTERNAL ASSESSMENT
Internal assessment is the assessment of the student by the teachers who teach them a particular subject.
The teachers themselves set the question papers or any other activities for evaluation, administer the
test and check the answer sheets. Sometimes, it may serve as a full dress rehearsal of external examina-
tion for the students. The marks obtained by the students may or may not be used for final grading of
the students. Internal assessment takes into consideration not only the scholastic but also non-scholastic
achievements (punctuality, attendance, sincerity, etc.) of the students. It fulfills the requirements of
continuous comprehensive assessment of the students by including a variety of e valuative activities, as
follows.
❑❑ Viva voce.
❑❑ Class work.
❑❑ Assignments.
❑❑ Project activities.
❑❑ Problem-solving activities.
❑❑ Clinical diary.
❑❑ Cumulative records.
❑❑ Written tests.
❑❑ Case presentation.
❑❑ Participation in declamation, debate, community health service activities (pulse polio program).
9.1. Purposes of Internal Assessment

❑❑ To help students know their strength and weakness so that they can be motivated to work hard.
❑❑ To inform teachers about the strength and weakness of their teachings.
❑❑ To provide feedback for the improvement of the course contents, teaching methods and teach-
ing–learning process.
❑❑ To reduce fear of external examinations.
❑❑ To assess social, moral and personality development of the students.
❑❑ To inculcate regular study habits among students.
❑❑ To assess learning difficulties of the students so that remedial actions can be taken by the teachers.
❑❑ To supplement external examinations.
❑❑ To manage the teaching–learning environment of the institution.
9.2. Advantages
❑❑ Validity: internal examinations are more valid as compared to external examination as it exten-
sively covers the whole curriculum through the tests conducted weekly or fortnightly.
❑❑ Reliability: it is a more reliable indicator of the student’s performance as it collects data over
extended periods of time.
❑❑ It motivates students to study regularly throughout the academic session, which in turn is helpful
to maintain discipline of the institution.
❑❑ It enables teachers to identify difficulty in teaching–learning process.
Chapter 10.indd 208 5/18/2012 11:50:11 AM

❑❑ It helps to explore potentialities among students and to overcome learning difficulties through
remedial actions taken by the teachers for individual student.
❑❑ Reduces fear of external examination among students as it makes students habitual to regular
tests.
9.3. Disadvantages
❑❑ It is a time-consuming activity that requires a lot of time on the part of the teacher to plan and
implement internal tests throughout the year.
❑❑ It may be not be cost effective.
❑❑ It may include subjectivity on the part of the teacher; favoritism may be another problem. Teach-
ers may become liberal and lenient because of their personal rapport with the students or some
pressure from outside.
10. CRITERION- AND NORM-REFERENCED EVALUATION

10.1. Criterion-Referenced Evaluation
It is an assessment technique where an individual’s performance is compared to a specific learning
objective or performance standard and not to the performance of other students.
Criterion-referenced assessment tells us how well students are performing on specific goals or stan-
dards rather than just telling how their performance compares to a norm group of students nationally
or locally.
In criterion-referenced assessments, it is possible that none or all of the examinees will reach a
particular goal or performance standard as it is based on prescribed learning outcomes.
10.1.1. Purposes
❑❑ Determine individual performance in comparison to some standard or criterion.
❑❑ Items based on standards given to students (i.e., objectives); most students should answer correctly.
❑❑ Discrimination is irrelevant and should not take place; discrimination may point to errors in
instruction.
10.2. N orm-Referenced Evaluation

Combined aptitude test (CAT) which is conducted for admission in Indian Institute of Management
(IIM) is an example of norm-referenced evaluation in which a particular examinee’s performance is
compared with other examinees, and finally scores are given in percentile and not in percentage.
Standardized tests compare students’ performance to that of a norm or sample group. Norm group is
the group of students who are in the same grade. Students’ performances are communicated in percen-
tile ranks, grade-equivalent scores, or scaled scores.
The term normative assessment refers to the process of comparing one test taker to his or her peers.
A norm-referenced test (NRT) is a type of test, assessment, or evaluation which yields an estimate
of the position of the tested individual in a predefined population, with respect to the trait being
measured.
Chapter 10.indd 209 5/18/2012 11:50:11 AM

10.2.1. Purposes
❑❑ To classify students across a continuum of achievement from high achievers to low achievers.
❑❑ Ascertains the rank of students.
❑❑ Determine individual performance in comparison to others.
❑❑ Items produce great variance in scores, perhaps with less than 50% scoring correctly.
❑❑ Item analysis is used to select those items that were answered correctly by those scoring high on a
test but incorrectly by those scoring low on a test (a positively discriminating item).
❑❑ It is inappropriate to use NRMs to determine the effectiveness of educational programs and to
provide diagnostic information for individual students; items cover a broad range of content and
often represent a mismatch between what is taught locally and what is taught in other states.
10.2.2. Disadvantages
❑❑ It cannot measure progress of the population as a whole, only where individuals fall within the
whole.
10.2.3. Advantages
❑❑ One among the many advantages of this type of assessment is that students and teachers alike
know what to expect from the test and just how the test will be conducted and graded.
TABLE 10.2 ifference Between Criterion-Referenced Tests and Norm-Referenced

D
Tests
Criterion-referenced tests Norm-referenced tests
Criterion-referenced test(CRT) is aimed to Norm-referenced test(NRT) is aimed to rank

determine whether each student has achieved the each student with respect to the achievement
learning objectives specified in the curriculum. of others so that, high and low achievers can be
discriminated.
At least four items are used to test every skill so that NRT uses less than four items to test every skill and
an adequate sample of student performance can be each test item is not equal in difficulty level so that
obtained for that particular skill. All these four test discrimination between high and low achievers can
items are equal in difficulty level. be made.
CRT is based on the learning objectives which are NRT is based on broad knowledge and skill areas
clearly specified in the curriculum. CRT identifies how that are chosen from a variety of textbooks, syllabi,
much an individual student has learned in relation to and the opinion of curriculum experts.
these objectives.
Each student’s score is not compared with the score Each student’s score is compared with other
of others students because it is irrelevant in CRT to students to assign percentile or a grade-equivalent
compare the scores of students with others. score for each student.
A student’s score is usually expressed as a Scores are expressed in percentile.
percentage.
Student achievement is reported for individual skills. Student’s performance is usually reported for broad
skill areas.
Chapter 10.indd 210 5/18/2012 11:50:11 AM

11. DEMERITS OF CONTINUOUS COMPREHENSIVE EVALUATION

11.1. Time Consuming
Continuous comprehensive evaluation is a time-consuming activity. Sometimes it may be difficult for
the teachers to plan and implement continuous comprehensive evaluation successfully.
11.2. Heavy Work Load for Teachers

The short-term evaluation increases the work load of teachers. Moreover, it demands training, effi-
ciency and resourcefulness on the part of teachers.
11.3. Incomplete Without External Examination

In the absence of external examination, a public examination at the end of the year is very essential in
every scheme of evaluation.
11.4. Unethical Practices

Bad things like bribery may increase in number and intensity.
Chapter 10.indd 211 5/18/2012 11:50:12 AM

CHAPTER HIGHLIGHTS
❑❑ Measurement refers to the process by which physical specification (length, height, weight) of an
object is determined. Measurement is the process of assigning a number to an attribute (or phe-
nomenon) according to a set of rules.
❑❑ Assessment refers to a test which is conducted to test the progress of the student against some
predetermined learning objectives.
❑❑ Evaluation is a systematic process to determine worth, merit, and significance of something or
someone (procedure, policy, curriculum, teaching methods, etc.) using criteria against a set of
standards.
❑❑ Evaluation process involves certain steps which start from determination of learning objectives to
collection and analysis of data.
❑❑ Lack of time, lack of skills to carry out evaluation, cost effectiveness, workload of the teachers,
lack of uniform standards of evaluation and lack of curriculum guidelines are some important
problems in evaluation.
❑❑ Principles of evaluation include principles of learning objectives, principle of continuity, principle
of comprehensiveness, reliable and valid tools and use of multiple techniques.
❑❑ Black and Wiliam consider an assessment ‘formative’ when the feedback from learning activities
is actually used to adapt the teaching to meet the learner’s needs.
❑❑ Formative assessment is the continuous comprehensive assessment of the student throughout the
year. It includes assignments, class tests, unit tests, midterm examinations, clinical case presenta-
tions, and drug presentations which are conducted weekly or fortnightly.
❑❑ Benjamin Bloom outlined a specific instructional strategy to make use of feedback and corrective
procedure, labeling it “learning for mastery” (Bloom, 1968), and later shortening the name to
simply “mastery learning” (Bloom, 1971).
❑❑ Black and Wiliam (1998) reviewed more than 250 studies on formative and summative assess-
ment and concluded that formative assessments, as opposed to summative ones, produce a more
powerful effect on student learning.
❑❑ Summative assessment refers to the evaluation of the students at the end of the session or term or
program for the purpose of certification, grading or placement of the students. When evaluation
focuses on the results or outcomes of a program, it is called summative evaluation.
❑❑ External examination involves the external components in terms of question paper, viva voce,
examiner and checking of answer sheets.
❑❑ Internal assessment is the assessment of the student by the teachers who teach them a particular
subject. The teachers set the question paper or any other activities for evaluation, administer the
test and check the answer sheets.
❑❑ Criterion-referenced evaluation is an assessment technique where an individual’s performance is
compared to a specific learning objective or performance standard and not to the performance of
other students.
❑❑ Norm-referenced evaluation is a type of evaluation in which a particular examinee’s performance
is compared with other examinees and finally scores are given in percentile and not in percentage.
❑❑ Criterion-referenced evaluation is aimed to determine whether each student has achieved the
learning objectives specified in the curriculum.
Chapter 10.indd 212 5/18/2012 11:50:12 AM

❑❑ Norm-referenced evaluation is aimed to rank each student with respect to the achievement of
others. So that high and low achievers can be discriminated.
❑❑ Disadvantages of continuous comprehensive evaluation are that it is a time-consuming activity,
puts a heavy workload on teachers, is incomplete without external examination, and can encourage
unethical practices.
EVALUATE YOURSELF
Q 1: Define evaluation? What are the principles of evaluation? (RGUHS 2010)
Q 2: Explain the difference between formative and summative evaluation?
Q 3: Write short note on internal assessment?
Q 4: What are the purposes of educational evaluation? (MGU 2007)
Q 5: Differentiate between criterion-referenced and norm-referenced evaluation?
Q 6: Explain the methods of internal assessment. (MGU 2008)
Q 7: What are the problems of evaluation?
Q 8: Explain differences in measurement and evaluation. (MGRUHS 2008)
Q 9: Explain the process of evaluation in detail.
Q 10: Criteria for selecting appropriate evaluation device. (NTRUHS 2009)
Q 11: How does evaluation differ from assessment and measurement? (AIIMS, 2006)
1. Crooks, T. (2001). The Validity of Formative Assessments, Paper presented to the British Educa-
tional Research Association Annual Conference, University of Leeds, 13–15 September
2. Cowie, B, and Bell, B (1999). A model of formative assessment in science education. Assessment
in Education, 6:101–116
3. Nicol, DJ and Macfarlane-Dick, D (2006). Formative assessment and self-regulated learning: A
model and seven principles of good feedback practice. Studies in higher education, Vol 31(2),
pp.199–218
4. Bloom, BS, Hastings,T and Madaus, G (1971). Handbook of formative and summative evaluation
of student learning. New York
5. Marzano, RJ (2006). Classroom assessments and grading that work. Alexandria, VA: Association
for Supervision and Curriculum Development.
6. Ainsworth, L, and Viegut, D (2006). Common formative assessments. Thousand Oaks, CA: Cor-
win Press.
7. Wang, TH (2007). What strategies are effective for formative assessment in an e-learning environ-
ment? Journal of Computer Assisted Learning. 23(3):171–186.
8. Assessment for Learning: 10 research-based principles to guide classroom practice, Assessment
Reform Group (2002), p.2
9. Boston, Carol (2002). The concept of formative assessment. Practical Assessment, Research and
Evaluation, 8(9).
Chapter 10.indd 213 5/28/2012 2:18:24 PM

10. Block, JH (Ed.). (1971). Mastery learning: Theory and practice. New York: Holt, Rinehart and
Winston.
11. Black, P., and Wiliam, D. (1998). Assessment and classroom learning. Assessment in Education,
5, 7–74.
12. Crooks, TJ (1988). The impact of classroom evaluation practices on students. Review of Educational
Research, 58, 438–81.
13. Harlen, W, and James, M (1996). Creating a positive impact of assessment on learning. Paper
presented at the annual meeting of the American Educational Research Association, New York,
April 1996.
Chapter 10.indd 214 5/18/2012 11:50:12 AM

c h a p t e r 11
Evaluation Tools
1. INTRODUCTION
Nursing students usually complain that there is no uniformity in the practical examination/test of medi-
cal surgical nursing or nursing foundation; some students were given the procedure of bedsore care, and
some were assigned oral care. Questions asked in viva voce were also different for every student. This
situation raises the question how the performance of the students can be compared with each other if
they are not given the same evaluation tools. In this type of exam there is a possibility that poor students
may luckily get easy procedures to perform and simple questions in viva voce, and hence obtain excel-
lent marks and vice versa. Can this type of test be a standardized test? In this chapter we will discuss
different evaluation tools as well as standardized and non-standardized tests.
2. STANDARDIZED TESTS
2.1. Meaning
A standardized test is one that is administered under standardized or controlled conditions. In other
words, a standardized test is a test that is administered and scored in a consistent manner; questions
and conditions under which the test is administered remain constant or consistent for all students (that
means date, time, and environmental settings of the test are same for all students). The scoring of the
questions follows a predetermined standardized procedure. Therefore, any examination in which the
same test is given in the same manner to all students is known as standardized test. It allows more reli-
able comparison of outcomes across all the students who have attempted the test.
On the basis of the description given above it can be concluded that a standardized test is one in which
❑❑ all test takers are given same questions to answer,
❑❑ they are allowed same amount of time to attempt questions,
❑❑ the test is administered under the same environmental conditions (controlled conditions),
❑❑ instructions are same for all the students,
❑❑ markings of the answers follow predetermined criteria,
❑❑ interpretation of the obtained marks is same for all students.
2.2. Characteristics of Standardized Test

Goodwin and Driscoll described the qualities of standardized tests as the following.
❑❑ They include specified procedures for administration and scoring.
Chapter 11.indd 215 5/18/2012 11:50:29 AM

❑❑ The test items are derived from experience; either by experiment or observation, rather than from
theory.
❑❑ They have an established format and set of materials.
❑❑ They present the same tasks and require the same response modes from all test takers.
❑❑ They provide tables of norms to which the scores of test takers can be compared in order to
ascertain their relative standing.
2.3. Pros of Standardized Tests

❑❑ It is fairer because all students are provided with the same test under the same conditions.
❑❑ Test results have a relative degree of validity and reliability.
❑❑ It provides results which are generalizable and replicable.
2.4. Cons of Standardized Tests

❑❑ It does not permit (or otherwise difficult) to measure creativity, critical thinking, conceptual think-
ing and other important attributes of nursing students.
❑❑ Misuse of these tests may narrow down the curriculum and can impair teaching and learning in
some way.
3. NON-STANDARDIZED TESTS
3.1. Meaning
Non-standardized tests do not follow the rules of standardized tests; hence, there is no uniformity in the
evaluation. There are different questions for the students and the test items are not standardized. For
example, the practical examination conducted in nursing is a non-standardized test because students are
evaluated on the basis of different questions in viva voce and different skills to perform in patient care;
therefore, it more or less becomes a chance factor for a student to score in the examination. Different
tasks assigned to students may not reflect the actual capabilities of the students, and hence the results of
non-standardized tests cannot be considered reliable.
In non-standardized tests students are provided with significantly different test items or the same
test items may be provided under significantly different conditions. For example, a group of students is
allowed 2 hours to complete the test while another group is allowed 3 hours; similarly, the same answer
is counted right for a particular student but wrong for another student.
Non-standardized tests do not permit comparison of the performance of the students with each other;
therefore, they do not allow calculating the relative standing of the students. It can only provide the in-
formation of individual students’ performances. Although, there is scope to measure students’ creativity,
critical thinking and other attributes which cannot be measured with the use of standardized tests.
3.2. Formats of Non-Standardized Tests

Non-standardized tests can be conducted in various formats as follows.
❑❑ Interview.
❑❑ Group discussions.
Chapter 11.indd 216 5/18/2012 11:50:29 AM

Evaluation Tools | 217
❑❑ Exhibition.
❑❑ Project work.
❑❑ Oral test or viva voce.
These are the formats in which individual students are assigned with different questions for the
purpose of evaluation. Results of these tests can provide information regarding the performance of in-
dividual students, but it fails to depict relative standing (rank) of a particular student in a group due to
lack of similarity of the assignment.
4. CHARACTERISTICS OF A GOOD TEST

Any test which fulfills certain criteria is termed as a good test because it ensures uniformity in the evalu-
ation. These criteria are validity, reliability and objectivity.
4.1. Validity
Validity is the judgment about a test’s ability to measure what it is intended or supposed to measure. It
refers to the appropriateness, meaningfulness and usefulness of inferences made from a test score. If a
test does not hit the intended target, no value can be attached to the results of such a test and it is termed
as an invalid test. For example, if a test or questionnaire is constructed to test the knowledge of students
about basic life support techniques but the test items are not related with the knowledge domain of the
basic life support then the test results cannot be considered valid as the test items were inappropriate.
4.2. Types of Validity

Validity can be of three types for a given test which are as follows.
4.2.1. Content Validity

It refers to the validity of the content of the test items; also it refers to the extent to which the test items
are representative of all possible items on the particular topic of interest. So, more number of items on a
particular test enhance content validity of a test as increasing the number of items enhances the representa-
tiveness of the test items. For the content validity of a test, it is advised to consult an expert in that particu-
lar field to make sure that the selected test items are representative of all the possible items on that topic.
4.2.2. Construct Validity

Construct validity means the test items are measuring the construct of interest and not any other similar
construct. For example, a test which is constructed to measure anxiety is said to be valid if it is measur-
ing anxiety, not other similar constructs like stress and depression. Construct validity refers to the extent
the scores on the test correlate with the presence of other qualities related to that which is being tested.
For example, a test which seeks to measure a student’s skill in history taking may be correlated with
the scores of a test which measures interviewing skill in general. A number of techniques are available
for the measurement of construct validity, some of which include known group techniques and multi
method matrix method.
4.2.3. Criterion Validity

Criterion validity refers to the relationship of a score on one measure (the test prepared by a teacher) to
another external measure. There are two ways to establish criterion related evidence.
Chapter 11.indd 217 5/18/2012 11:50:29 AM

4.2.3.1. Concurrent Validity: It is the correlation of a test score with another measure that occurs
at the same time, e.g., correlation between clinical course grades with didactic course grades. If the
scores correlate then the newer test is considered to have concurrent criterion validity. It is valid because
it gives the same result as a known standard criterion.
4.2.3.2. Predictive Validity: It is the correlation of a test score with another measure that occurs in
future means. In other words, the test result predicts a later outcome. For example, predictive validity of
an entrance test can be established if the final grades of the students are same as the entrance test results.
4.2.4. External and Internal Validity

The external validity of a test refers to the extent to which test results can be generalized to the entire
population of the interest. The internal validity of a test is the extent to which it measures what it is
supposed to measure.
4.3. Factors Influencing Validity

Teacher must be aware of these factors in order to avoid the pitfalls which can decrease the validity of
a test.
Factors pertaining to test
❑❑ Unclear direction.
❑❑ Difficulty and ambiguous phrasing of questions.
❑❑ Inappropriate items.
❑❑ Improper arrangement of items.
❑❑ Identifiable pattern of answers and clues.
❑❑ Insufficient number of test items.
❑❑ Error in scoring.
Student factors
❑❑ Physical illness.
❑❑ Lack of motivation.
❑❑ Emotional disturbance.
5. RELIABILITY
A test is said to be reliable when it consistently measures a given performance in the same way on re-
peated testing. It refers to the consistency of the assessment tools, e.g., if a test is given on more than one
occasion and students achieve the same scores, it is said to be a reliable test. It is a mathematical concept
and is a measure of correlation between two sets of scores. To determine the reliability of a particular
test, three alternative methods are available that can be used, which are as follows.
5.1. Test–Retest
In this method of reliability testing, the same test is administered after an interval to the same student
and then scores of the test and retest are correlated to compute the reliability coefficient.
Chapter 11.indd 218 5/18/2012 11:50:29 AM

5.2. Equivalent Test

Two tests of equivalent form can be administered to the students to obtain two sets of scores. It is a
useful method of reliability determination for checklist, rating scale type of tests.
5.3. Split Half Method

In this method, a single test is split into two halves (e.g., odd and even number of multiple-choice ques-
tions—MCQs) and the two sets of scores for each student are compared. This method of reliability
testing is useful to determine the internal consistency of a test in which all the test items are measuring
a single construct of interest.
6. MEASURE TO IMPROVE RELIABILITY

❑❑ Increase length of the test to the optimum level.
❑❑ Use appropriate level of difficulty and discrimination (described later in this chapter) to ensure a
widespread of scores.
❑❑ Maintain conditions of the test constant for all the test takers.
❑❑ Ensure objectivity of scoring.
❑❑ Ensure validity of instrument used.
7. OBJECTIVITY
Objectivity means a test should have no scope for subjective biasness of the examiners. It should re-
move the variability of judgment between different examiners. It signifies the extent to which indepen-
dent and competent examiners agree on what constitutes a good performance. There are three areas in
which a student’s performance is measured in nursing sciences which includes knowledge, skills and
attitude. Let us see which tools are available to evaluate these performance areas.
8. EVALUATION TOOLS FOR THE ASSESSMENT OF KNOWLEDGE

Theoretical knowledge of a student can be assessed with the use of essay type questions, short-answer
questions, MCQs and many other different methods. In the next section we will discuss essay type
question, short answer type questions and MCQs.
8.1. Essay Type Questions

Go through to the following questions.
Q 1: Discuss health problems of India in the 21st century.
Q 2: Critically analyze Orem’s theory in detail.
Q 3: Calculate fluid requirement for a woman with 60 kg body weight and 50% full thickness burn.
These are some questions which are frequently encountered in university exams. The students are
supposed to write the answers of these questions in essay format by recalling and organizing facts
(question no 1), by presenting a debate on the issue (question no 2), or by applying theoretical knowledge
for a given situation (question no 3). These questions are known as essay type questions.
Chapter 11.indd 219 5/18/2012 11:50:29 AM

8.1.1. Definition
“Essay type questions require students to write answers in essay format in their own words
resulting in different pattern of answers for a particular question which are subsequently judged
by an expert subjectively. Such questions are aimed to assess the synthesis, application, analysis
and other higher domains of cognitive abilities as well as writing, organizing and expressive skills
of the student.”
—A B Patidar (2010)
Since there is no single pattern of response that can be labeled as correct, it provides a range of flex-
ibilities to the student to write the answers. It leads to subjective evaluation of the answers by an expert
teacher; hence, the validity and reliability of essay type questions are always suspect if honest efforts
are not put in framing the questions by the teacher.
Essay type questions are ideal for assessing a student’s ability to apply knowledge to solve problems,
summarize, hypothesize, and find relations. They can also evaluate the writing and organizing ability
of the students. When constructing essay questions, it is essential to define the criteria on which the
answers will be judged.
8.1.2. Purpose
Essay type questions are subjected to criticism by the educationist but still they are used in university
exams across the globe. One might argue that when there are so many loofalls associated with essay
type questions then why are this type of questions consistently being used for evaluation in nursing
sciences. This is because essay types questions serve distinct purposes, which are as follows cannot be
accomplished by any other type of questions.
❑❑ It provides students to express their views on particular phenomena.
❑❑ Factual recall of knowledge: sometimes the teacher is interested to know how students can better
recall the facts which they have learned. This purpose can be fulfilled by having essay type ques-
tions on the test paper.
❑❑ Analysis/explanation of relationships: when the teacher is interested to know how the students can
better explain the relationship between two or more concepts, then he or she has to use essay type
questions, because no other type of question can serve this purpose.
❑❑ Creativity, writing style, organization, neatness and cleanliness are some other attributes that can
be assessed by essay type questions.
8.1.3. Principles for Construction

❑❑ The learning objectives to be evaluated by an essay type question should be clearly defined in
simple words.
❑❑ If a learning objective can be evaluated by any other type of question, then essay type questions
should be avoided in this situation.
❑❑ Use several short essay type questions instead of long ones.
❑❑ Specify the approximate time and word limit for each essay type question.
❑❑ Explain the distribution of marks for different segments of a particular question as well as for
organization, neatness and expressive language, if any.
❑❑ Avoid complex and ambiguous words.
Chapter 11.indd 220 5/18/2012 11:50:29 AM

❑❑ Avoid questions that are too broad in scope and allow for vague answers.
❑❑ Use words like “differentiate” and “compare” at the beginning of the question to restrict the scope
of the answer.
❑❑ Use simple unambiguous language that is well understood by all students.
❑❑ Improve the essay question before and after the test is conducted.
8.1.4. Before the Test is Conducted

❑❑ Review the wording of the question, consult with an expert.
❑❑ Write a model answer that will be helpful while evaluating the answers provided by the students.
Model answer has to be prepared with the help of at least three subject experts.
❑❑ Identify the critical points which must be present in the answer.
8.1.5. After the Test is Conducted

Examiner has to review the answers provided by the students to learn whether the students has clearly
understood the language of question or whether there was any confusion. If it is felt that there was dif-
ficulty in understanding the question as reflected by the pattern of answers, the question has to be modi-
fied appropriately for the next use.
8.1.6. Criteria for Answering

❑❑ Students are required to write or compose their answers in their own words.
❑❑ Students have to stick to the time and word limit as specified in the instructions.
❑❑ It requires subjective judgment by a subject expert to judge the accuracy of the responses.
8.1.7. Pros of Essay Type Questions

❑❑ It is helpful to assess critical thinking skills among student nurses.
❑❑ Helpful to evaluate thinking, recall, analysis and synthesis of facts.
Description: Student has to provide Evaluation: In this type of question, the

relevant information asked in the question. student has to put up an arugument on
Commenting is not required; the student both sides of the coin for the given
may use examples and research situation. It requires supporting data to put
evidences to support the answer it up a strong argument. Finnaly the student
usually uses words like “explain”, has to finish with concluding remarks.
“describe” etc. It uses words like “justify”, “evaluate” etc.
Essays
Types
Comparison: Students are required to Questions Discussion:The student is required to
compare the given situations in terms present the main facts, discuss the pros
of similarities, differences, and pros and cons of the situation, comment in his
and cons. It uses words like “contrast”, or her own words with supporting data,
“differentiate” etc. and provide implication for nursing practice,
administration or whatever applicable.
It uses words like “interpret”, “explain”, etc.
Figure 11.1 Essay Type Questions
Chapter 11.indd 221 5/18/2012 11:50:30 AM

❑❑ Provides opportunity for creative expression, organization of facts.

❑❑ Relatively easy to construct.
❑❑ Limited scope of guessing of answers.
8.1.8. Cons of Essay Type Questions

❑❑ Leads to vague answers if wordings of question are not simple and ambiguous.
❑❑ It is time consuming to assign marks to the answers.
❑❑ Evaluation is subjective, different teachers may give different marks to the same answer.
❑❑ There is scope of lot of subjective biasness.
Examples of Essay Type Questions

Examples of Poor Essay Type Questions
1. Discuss infective endocarditis. 8 marks
2. Describe myocardial infarction. 10 marks
3. Discuss the nursing management for a burn patient. 9 marks
Examples of Better Essay Type Questions

1. Define infective endocarditis. List its sign and symptoms, and explain medical management
of a patient with infective endocarditis. 1 + 3 + 4 = 8
2. Define myocardial infarction. List the cardiac markers which are used to diagnoses MI.
Explain pathophysiology of MI with the help of flow chart. Explain three priority nursing
diagnosis for a patient of MI. 1 + 3 + 3 + 3=10
3. List four priority nursing diagnosis and explain nursing interventions for each nursing
diagnosis for a burn patient admitted in emergency department. 3 + 3 + 3 = 9
Example of the Best Essay Type Questions

1. Mr. Sanjay 45 years old male, is a software engineer having the personal history of chronic
smoking was admitted in casualty with the complaint of chest pain, nausea, dyspnoea and dia-
phoresis. On assessment his heart rate was 112/min, blood pressure 100/60 mm Hg and Trop
t test was positive. (15 marks)
(a) What is the diagnosis of Mr. Sanjay?—1
(b) List the risk factors he has for that particular diagnosis.—2
(c) Explain pathophysiology of the diagnosed medical condition—3
(d) List three priority nursing diagnosis and their interventions in detail—6
(e) What complications can Mr. Sanjay develop in the emergency department?—3
8.2. Short-Answer Questions

Short-answer questions are a type of open-ended questions which require responses in either one
word or a few sentences. They are slightly less structured as compared to MCQs and are more struc-
tured when compared with essay type questions. Students are provided with no choices or alternatives
Chapter 11.indd 222 5/18/2012 11:50:30 AM

to answer the questions; therefore, they have to create an answer for the given question. “Fill in
the blank” and “completion” type questions are examples of short-answer question types. Since the
response is typically short, there is no or very less scope of subjectivity while assigning marks to
answers.
Open-ended questions are more flexible because they can test issues that require creativity and
spontaneity. Short-answer open-ended questions should be aimed at the aspects of competence that
cannot be tested in any other way.
8.2.1. Purpose
❑❑ Useful to assess the recall ability of the students (lower cognitive domain).
❑❑ To assess the students in the classroom while a lecture is in progress.
❑❑ Useful in formative assessment.
8.2.2. Principles for Construction

1. Use precise, simple and unambiguous language.
2. Use action-oriented verbs.
3. Each question should deal with important content area of a unit.
4. Avoid long complex sentences; keep them as simple as possible.
5. Avoid phrases like “write briefly on…., short notes on…..” etc.
6. Provide space for writing the answer as per the requirement of the question.
7. Choose a specific problem to formulate the question that will have a distinct, specific answer.
8. Fill-in-the-blank-type questions should use such statements that omit only one or two key words
(answer) at the end of sentence.
8.2.3. Pros
❑❑ Can be administered to large groups of students for a short formative assessment.
❑❑ Useful to assess the recall of information without any assistance, cues or alternatives.
❑❑ Require less stationary as compared to essay type questions.
❑❑ Less scope of subjectivity in the judgment of the answer as compared to essay type questions.
8.2.4. Cons
❑❑ Not useful to test higher cognitive domain.
❑❑ Can lead to unethical practice within a group of students if the examination hall is not spacious
enough.
❑❑ Can lead to difficulties in scoring if the question is not worded carefully.
❑❑ Provide no scope to assess the writing ability, expression, organization of answer, etc.
8.2.5. Types of Short-Answer Questions

1. Fill-in-the-blank type.
2. Statement completion.
Chapter 11.indd 223 5/18/2012 11:50:30 AM

Figure 11.2 Human Eye
3. Short answer in 5–10 words.

4. Labeling a diagram.
Examples
❑❑ Miss Florence Nightingale was born in the year________________.
❑❑ List three ECG changes in myocardial infarction.
❑❑ List the classical symptoms of Parkinson disease.
❑❑ Label the following diagram (Figure 11.2).
8.3. Multiple-Choice Questions

MCQs are widely used in various entrance examinations wherein thousands of students appear. MCQs
are standardized type of tests which have high reliability and validity. A typical MCQ begins with a stem,
which consists of an incomplete statement, a picture or graph followed by 4–5 alternatives or choices. All
the wrong answers or alternatives are termed as distracters and the correct answers are known as the key.
Clear instructions are provided at the beginning of the questionnaire about the selection of the answer (e.g.,
choose one response which is correct; choose all responses which are correct, etc.) or instructions can be
provided within the sections of the questionnaire whenever necessary. Scoring of MCQs is easier than the
essay and short-answer-type questions, but it is equally difficult to construct good quality MCQs.
8.3.1. Characteristics of Multiple-Choice Questions

❑❑ Each question consists of a base or stem written in clear and simple words.
❑❑ Stem is followed by 4–5 distracters.
❑❑ Students choose the correct answer from the given alternatives as per the instruction.
❑❑ Each question has specified marks; typically, students will get either full marks or no marks for a
given question (some MCQs may be exceptions in which there are more than one correct answer).
❑❑ Markings of the answers made by the teacher are purely objective, as there is no scope of subjective
biasness.
❑❑ Answers can be checked by computers or by any other person who is supplied with the answer key.
Chapter 11.indd 224 5/18/2012 11:50:30 AM

8.3.2. Types of Multiple-Choice Questions

There are a number of formats available for framing MCQs. Following are some important formats of
MCQs which are used by institutes of repute in the field of nursing education and other agencies in India.
❑❑ Single best response.
❑❑ Multiple true and false.
❑❑ Reason assertion.
❑❑ Matching items.
8.3.2.1. Single-Best-Response Type: In this type of MCQ, students are asked to choose the single
best response from the given 4–5 choices, or alternatives. There is debate among researchers and educa-
tionists on whether the number of alternatives, or choices, should be four or five for this type of MCQs.
Research has shown that there is no benefit of having five choices; hence, most of the educationists use
only four choices. Extreme care should be taken to use “none of the above”, “both A and B” and “all of
the above” choices in test items. It is better to avoid these phrases; if used, then it should be ensured that
these choices are true for some questions and wrong for some others. Following are some examples of
the single-best-response type of MCQs.
Example 1
Saw tooth pattern in EKG represents
(a) Atrial fibrillation (b) Atrial flutter
(c) Right bundle branch block (d) Left bundle branch block
Example 2
The given ECG strip shows
(a) Ventricular fibrillation (b) Atrial fibrillation

(c) Atrial flutter (d) Ventricular tachycardia
Example 3
Following are the symptoms of diabetes, except
(a) Polyuria (b) Polydypsia
(c) Polyphasia (d) Polyarthrites
Note: Whenever using the word except or not it should be written in bold and italic style, so that
students can easily capture that it is a negative statement.
Example 4
Which of the following is not a fat-soluble vitamin?
(a) Vit A (b) Vit C
(c) Vit D (d) Vit E
Chapter 11.indd 225 5/18/2012 11:50:30 AM

8.3.2.2. Multiple True-False Types: In this type of MCQ, the stem or base is followed by 4–5
statements that are mutually not exclusive. Students are instructed to choose all the alternatives which
are true or otherwise; guidelines or keys can be framed as per the requirement. Students are asked to
pick the appropriate key/s which is/are correct for the given test item. This type of questions requires
comprehensive understanding of the topic by the students in order to answer the questions.
Example 1
Instruction: Select all the alternatives which are right answers.
Which of the following are not fat-soluble vitamins?
(a) Vit A (b) Vit C
(c) Vit B (d) Vit E
Example 2
Instruction: Answer the following question in the appropriate space using the given key:
(a) Only 1 and 2 are correct
(b) Only 1 and 4 are correct
(c) Only 4 is correct
(d) Only 1, 2 and 3 are correct
Modified John’s criteria for the diagnosis of acute rheumatic fever consist of
1) “Carditis” as major criteria
2) “Arthralgia” as minor criteria
3) “Sydenham’s chorea” as major criteria
4) “Fever” as major criteria
Example 3
Instruction: Read the stem given below carefully and consider the subsequent statements. Tick
mark “T” if the statement is true or “F” if the statement is false.
Hemodialysis is a term used to describe the removal of solutes and water from the blood across a
semi-permeable membrane.
(a) Hemodialysis is based on the principle of ultra filtration. T/F
(b) AV fistula provides an easy access for hemodialysis. T/F
(c) Hypertension is a complication during hemodialysis. T/F
(d) Disequilibrium syndrome occurs during hemodialysis. T/F
Key: a) T, b) T, c) F, d) T
Note: Multiple true and false types allow any combination of true and false, or all true, or all false.
8.3.2.3. Reason-Assertion Type: This type of MCQs is used to assess higher cognitive domain of
the students. It is frequently used in competitive exams conducted by Union Public Service Commis-
sion, various state public service commissions and Staff Selection Commission (SSC) in India.
Test items typically consist of two statements in which one is “assertion” and other is “reason”. Com-
mon key items are provided for 5–6 questions and students are asked to select the appropriate key for a
particular test item. It is difficult to score this type of MCQ as compared to other types.
Chapter 11.indd 226 5/18/2012 11:50:30 AM

Example 1
Instruction: Mark the right answer in appropriate space provided for it using the following key
for question nos. 1 and 2. Each question consists of two statements; one is assertion and the other
is reason.
Key:
(a) Both the statements are true and the reason is the correct explanation of the assertion.
(b) Both the statements are true and the given reason is not the correct explanation of the assertion.
(c) The assertion is true but the reason is a false statement.
(d) The assertion is false and the reason is a true statement.
(e) Both the reason and assertion are false statements.
Q 1:
Assertion: Lithium therapy is most effective in mood disorders.
Reason: Lithium replaces sodium from cells, which causes increased risk of hypernatremia.
Q 2:
Assertion: Right ventricle failure is manifested by dependent edema and increased jugular ve-
nous pressure.
Reason: Right ventricle failure leads to increased peripheral pooling of blood and increased capillary
hydrostatic pressure.
8.3.2.4. Matching Type: In this type, there are two groups of statements. Students are asked to
match a particular statement of group A to the appropriate statement of group B.
Example 1
Instruction: Match the statements of group A to the appropriate statement of group B. Group
A consists of names of Indian leaders and group B consists of the positions they held in Indian
politics.
Group A Group B
(a) Lal Bahadur Shastri (x) President
(b) Bhairon Singh Shekhawat (y) Prime Minister
(c) Shivraj Singh Chauhan (z) Chief Minister (MP state)
Key: (a) y, (b) x, (c) z.
Note: There may be a provision that the statements on the right-hand side (group B) can be used
more than once to match the statement of left-hand side (group A).
8.3.2.5. Guidelines to Construct Good MCQs

❑❑ The stem of the test item should be in clear, simple language and should not be unnecessarily
lengthy.
❑❑ Stem of the item should be in positive form, wherever possible.
❑❑ Negative wordings should be clearly contrasted in the stem by underlying or using bold italic fonts.
❑❑ Double negative statement should be avoided in the stem of the test item.
Chapter 11.indd 227 5/18/2012 11:50:30 AM

❑❑ All the alternatives should be grammatically consistent with the stem of the test item.
❑❑ Carefully avoid verbal clues which might enable students to select the correct answer or eliminate
an incorrect alternative.
❑❑ Avoid similarity of wording in both the stem and the right answer.
❑❑ Avoid absolute terms (e.g., never, always, none) in the distracters because it makes the correct
answer obvious or increase the chances of guessing the correct answer.
❑❑ Make the distracters similar to the correct answer in both length and complexity of wording.
❑❑ Vary the relative length of the correct answer to eliminate length as a clue.
❑❑ Avoid use of the alternative such as “all of the above” and “none of the above” whenever possible.
❑❑ Make sure that each test item is independent of the other items and is not providing leading
answers.
❑❑ Wordings of the statements in true–false items should be precise so that they can be judged
unequivocally true or false.
8.3.3. Pros of MCQs

❑❑ Easy to use.
❑❑ Can cover large content area of syllabus in the examination.
❑❑ Easy to administer.
❑❑ Easy to check answers.
❑❑ High reliability and validity.
❑❑ No scope of subjective biasness.
8.3.4. Cons of MCQs

❑❑ Not useful to test highest level of cognitive domain.
❑❑ Difficult to construct good MCQs.
❑❑ Provide opportunity to speculate the answer if questions are not properly constructed.
❑❑ Most suitable format for unethical practice among students if invigilator is not a highly keen
observer.
9. EVALUATION OF SKILLS
The tools used for the evaluation of skills are as follows.
❑❑ Observation check lists.
❑❑ Rating scale.
❑❑ Anecdotal records.
❑❑ Critical incident record.
9.1. Observation Checklist

It is a two-dimensional tool used to assess and record the presence or absence of behavior, trait or activity
when the incident had occurred. Development of a checklist requires a category system which involves
listing all those behaviors that the observer is intended to observe and record. Decision has to be made
Chapter 11.indd 228 5/18/2012 11:50:30 AM

by the evaluator regarding the exhaustiveness of the phenomenon and the number of categories to be in-
cluded in the checklist. A checklist does not permit to rate the frequency or extent of the behavior or trait.
Advantages of Checklist
❑❑ Adaptable to most subject matter that are observable.
❑❑ Can evaluate learning activities in relation to procedure, process, personal trait or characteristics.
Limitations of Checklist
❑❑ Determines only presence or absence of an action, behavior or trait.
❑❑ Provides no means of determining the extent to which a behavior or trait is possessed by the
student.
1. Total marks ___________
2. Signature of examiner
3. Date:
9.2. Rating Scale

As mentioned earlier, the checklist cannot quantify the extent or frequency of observed behavior; there-
fore, rating scale is a useful tool which eliminates this limitation of the checklist. It is a device which
facilitates appraisal of number of traits or characteristics in reference to a common qualitative scale of
values. It provides the scope of quantification of the judgment in relation to an observed behavior of the
TABLE 11.1 Checklist for Oral Medications

Note: please mark tick (√) in appropriate column for each step
Steps Yes No
Wash hands
Recall safety measures
Locate drug, read the label on exact bottle and see that it is the right medicine and shake
the bottle
Collect medicine in to the container
Measure liquids accurately with a minim glass and read the lower level of the meniscus
Pour liquid from side opposite of the label, wipe the mouth of the bottle, recap the bottle.
Take tablet/capsule in a spoon or medicine cup
Identify the patient from the patient chart
Explain the procedure
Place patient’s towel under the chin
Position the patient comfortably in upright sitting position
Administer each drug separately followed by water
Record the drug given, details of dose, route, date, time, signature, omissions, etc.
Clean and replace the articles
Chapter 11.indd 229 5/18/2012 11:50:30 AM

student. A rating scale may have 5–7 points of rating in the form of abstract labels (quantitative) along
with their descriptions. For example A, B, C, D, E or 5, 4, 3, 2, 1.
Qualitative form: Superior—5
Above average—4
Average—3
Poor—2
Very poor—1
Sometimes, frequency labels, like always, usually, frequently, sometimes and never, can be used
depending upon the trait which is to be rated. These abstract labels are assigned a numerical value to
quantify the frequency and extent of the observed behavior.
Bondy (1983) developed criterion-reference-rating scale in which there are five levels of competency as
follows.
❑❑ Independent.
❑❑ Supervised.
❑❑ Assisted.
❑❑ Marginal.
❑❑ Dependent.
Types of Rating Scales

9.2.1. Descriptive Rating Scale
It provides for each trait a list of descriptive phrases from which the rater selects the one most applicable
to the student and records his or her selection, usually by means of a (√) mark.
Sample of Descriptive Rating Scale
Student Name: Mr. Yuvraj
Clinical Area: Neurology ward
Date: 24/07/2011
3 2 1
RATING ITEM DEPENDENT INDEPENDENT PARTLY DEPENDENT
Behavior
Problem-solving skill
Physical examination
History taking
Key
Independent: student is able to handle it on his/her own.
Partly independent: student is able to solve simple problem.
Dependent: needs help in solving complex problem. Withdraws from it and needs counseling and
guidance.
Total Score range: 4–12
Chapter 11.indd 230 5/18/2012 11:50:30 AM

Interpretation of the score obtained by a particular student

10–12: Superior
7–9: Above average
4–6: Average, needs improvement
Comments:
__________________________________________________________________________________
__________________________________________________________________________________
Signature of the Supervisor Date: ________________
9.2.2. Numeric Rating Scale

The rater assigns a code number (which refers to a descriptive phrase), to each trait of the person be-
ing rated. Code numbers are assigned to the descriptive phrases, arranged in order of degree or level at
which they indicate possession or lack of occurrence of each trait.
Sample of Numerical Rating Scale

Student’s name :
Clinical Area :
Date :
Excellent Very Fair Poor Very

Behavior good poor
5 4 3 2 1
1. Able to identify the priority needs
of patients
2. Communication with the patient
3. Evaluation of the interventions
Total score range: 3–15

Interpretation of the total score obtained by the student
13–15: Excellent
10–12: Very good
9–11: Fair
6–8: Poor
3–5: Very poor
For example, if a student obtains a total score of 5, then his overall rating will be very poor.
Signature of Student Signature of Instructor

Date Date
9.2.3. The Graphic Rating Scale

The graphic rating scale has descriptive phrases printed horizontally at various points (underneath
as straight line across the page) The rater indicates the performer’s standing in respect of each trait by
placing a check mark at an appropriate point along the line.
Chapter 11.indd 231 5/18/2012 11:50:30 AM

Sample Graphic Rating Scale for Assessment of Workshop

Instructions: Place a tick mark (√) on the line at its points which best describes the person
Name of Student:
Class:
Date:
FREQUENTLY MAKES OCCASIONALLY DOES

SLOPPY WORKER MISTAKES FINE WORK EXCELLENT WORKER
1 2 3 4
Careless about use of Careless in use and Need help in looking Takes care of
equipment handling of equipment after equipment at equipment in a
times professional manner
Ensures patients’ safety
and comfort
Key:
1 and 2: Need constant supervision
3: Needs guidance
4: No need for supervision
Date: Signature of instructor
Uses of Rating Scale: Rating scales can be used to evaluate skills, outcome, activities, interests and
attitudes.
Advantages of Rating Scale
❑❑ Rating scale is a standard device which records qualitative and quantitative judgment of the
observed performance.
❑❑ Measures specified outcome.
❑❑ It is easy to administer and score.
❑❑ It can be used for large groups of students.
❑❑ Immediate feedback can be provided to the students.
Disadvantages
❑❑ Misuse of the rating scale can decrease its objectivity; hence, diluting the purpose of evaluation.
❑❑ Problems of central tendency effect, halo effect and horn effect.
9.2.4. Basic Principles for Preparing Rating Scales

A rating scale should
❑❑ directly relate to learning objectives;
❑❑ be confined to those performance areas that can be observed;
❑❑ provide three to seven rating positions;
❑❑ have a provision to omit items that are unqualified to judge;
❑❑ be oriented to the specific scale as well as the process of rating in general.
Chapter 11.indd 232 5/18/2012 11:50:30 AM

9.3. Anecdotal Record

An anecdotal record is a running description (snapshot) of specific behavior of a student as observed by
the teachers that is considered important for evaluation purpose. It may be defined as a factual record of
an observation of a single, specific and significant incident in the behavior of a student.
Characteristics
❑❑ It is factual recording only of the actual event, incident or observation, uncolored by the interpre-
tations or biases of the observer.
❑❑ It is a record of only one incident.
❑❑ It is a record of an incident which is considered important and significant for the evaluation pur-
pose of the student.
Uses of Anecdotal Record
❑❑ It can be used in those areas of behavior that cannot be evaluated by other methods.
❑❑ It provides direct feedback to the students to understand and improve their behavior.
❑❑ It can be used to supplement and validate observation made by some other means.
❑❑ Records both positive and negative incidents of students’ behavior.
❑❑ Anecdotal record should have interpretative value.
❑❑ Anecdotal record should be emphasized as an educational learning resource.
Principles to Make Effective Anecdotal Records
❑❑ Restrict observations to those aspects of behavior which cannot be evaluated by other means.
❑❑ Observation should be selective and should include 1–2 behavioral aspects at a time.
❑❑ An observation blueprint or guide should be prepared in advance.
❑❑ Anecdotal record should be complete in all aspects.
❑❑ Record the incident as soon as possible after its occurrence.
❑❑ Anecdotal record should be compiled and filed.
❑❑ Anecdotal record should not be confined to recording of negative behavior pattern only.
Sample: Anecdotal Record Form
Name of the Student:
Date and Time:
Class: Setting:
Incident:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Interpretation:
__________________________________________________________________________________
__________________________________________________________________________________
Chapter 11.indd 233 5/18/2012 11:50:31 AM

9.4. Critical Incident Technique

The critical incident technique is a learning as well as evaluation tool which uses direct observation
to collect data of nursing students’/staff nurses’ behavior that have critical significance and meet
some methodically defined criteria to evaluate their performance in the given role. A critical incident
can be described as one that makes a significant contribution either positively or negatively to a
phenomenon.
The history of critical incident reports dates back to the time of World War II. J. C. Flanagan invented
this technique as a means to understand causes of airplane crashes during the World War (described in
Psychological Bulletin, Vol. 51, No. 4, July 1954). Thereafter, Mezirow and Brookfield speculated that
critical incidents enhance learning among the medical students by providing access to experiences that
facilitate personal growth.
Discussions of critical incident reports can inculcate moral values among nursing graduates in an
environment where they are being challenged. Reawakening of nursing students’ values is especially
important at times when they are exposed to stress, sleep deprivation, and even burnout. It allows
nursing graduates to better understand their roles in the given clinical setting. Critical incident
reports provide an effective learning method to address ethics and professional values in nursing
education.
As a learning tool, the critical incident technique includes five major areas. The first area is deter-
mining and reviewing the incident, then finding the facts pertaining to the incident, which involves
collection of data from those involved in the incident. After the data is gathered from the participants,
issues are identified which is followed by a discussion on how to resolve these issues. Various possible
solutions are explored and evaluated and the most suitable solution is accepted to resolve the root cause
of the situation.
As an evaluation tool, a teacher can use it to identify and measure the attitude and behavior of
the nursing students in light of professional development and performance in the given situation. The
teacher records the critical incidents based on his or her memory of the behavior, attitude and perfor-
mance of the nursing students in a given situation, which is considered to be critical for the professional
development of the students.
Critical incident technique has also proven to be an effective tool for identification of organizational
problems. It can also be used as an interview technique where the interviewees are encouraged to talk
about unusual organizational incidents instead of answering direct questions.
Disadvantages
❑❑ The critical incident technique relies on events being remembered by teachers which may lead to
inaccurate recording of event.
❑❑ Teachers may not be aware of which incident to be considered as critical.
9.5. Objective Structured Practical Examination

Objective structured practical examination (OSPE) is the latest innovative standardized technique of
evaluation used in nursing sciences, which solves the issue of inconsistency of practical examinations
as described in the beginning of this chapter. It is a technique of evaluating skills of students where
students are given specifics questions related to the skills to be tested and are asked to demonstrate
the desired skills in a given time by going through the different stations in an orderly manner. The
Chapter 11.indd 234 5/18/2012 11:50:31 AM

s tudents are awarded scores by the examiners in proportion to the competency level demonstrated by the
students.
Characteristics of OSPE
❑❑ Each student is allotted a number. This will be the number of the station at which he or she would
start.
❑❑ Clear instructions are given at each station as to what a student should do.
❑❑ At each station a student demonstrates a skill, makes observations, calculates from data provided
or answers the questions asked.
❑❑ Students rotate around all the OSPE stations spending 2 or 3 minutes at each station. A bell rings
at the beginning and at the end of each 2 or 3 minutes.
❑❑ All the students enter the allotted OSPE stations at the same time, demonstrate the desired skills
as soon as the bell rings and go through all the stations. At the end of the examination they remain
at their last station till asked to leave.
❑❑ Examiners take positions from where they can have a good view of the candidates’ performances
at the various stations.
❑❑ Examiners have a checklist or rating scale on which they tick as they observe the performance of
a student at a skill station. They take a fresh copy of the checklist for every candidate.
❑❑ Questions are identified in terms of the station number which is printed on cyclostyled sheets so
that a copy can be given to each student and the same sheet serves as the answer sheet. The key to
the questions is prepared beforehand.
❑❑ At the end of the examination, the checklists of examiners pertaining to a given candidate and his
or her answer sheets are put together to calculate the total score of a student.
OSPE stations
Each OSPE station has a question which may include some calculations, demonstration of a skill, iden-
tification of an instrument or calculation of drug dose and side effects. Questions should be written in
clear and unambiguous language. An example of OSPE items is as follows.
Response station-1
List the indications, and desired dose of the given drug and also write THREE nursing responsibilities
specific to this drug.
Response station-2
Identify the given instrument and list the TWO uses of the instrument.
Response station-3
Write the name of the arrhythmia depicted by given ECG strips.
Chapter 11.indd 235 5/18/2012 11:50:31 AM

Response station-4
Mr. Mahesh, 30 years old, male, 70 kg weight, was admitted in casualty with 30% partial thickness
burn. Calculate the total fluid requirement for Mr. Mahesh and how much fluid you will administer in
the first 24 hours.
Response station-5
An elderly male is receiving mechanical ventilation. The arterial blood gases for this morning are pH
7.24, PaCO2 50 mm Hg, and HCO3 24. Interpret these ABG values.
Response station-6
Mr. Ram is opening his eyes to painful stimulus, is using inappropriate words, and is showing extension
to pain. What is the GCS score of Mr. Ram?
Response station-7
What are the usual values for the given mechanical ventilator parameters for an adult patient.
1. Tidal volume
2. PEEP
Advantages of OSPE
❑❑ It is a reliable and valid evaluation tool.
❑❑ It can test the achievements outlined in the objectives.
❑❑ Examiners can carefully design the examination in advance.
❑❑ Examiners can control the content and complexity of the examination.
❑❑ Emphasis is shifted from testing merely factual knowledge to testing a wide range of skills in a
short time.
❑❑ Examination covers a wide spectrum.
❑❑ All students are subjected to the same standardized test.
❑❑ Use of checklists and MCQs makes the test more reliable and valid and less dependent on the
mood of the examiner as happens in traditional practical examinations.
Disadvantages
❑❑ Takes a lot of time and effort to prepare the test.
❑❑ Provides little or no opportunity for measurement of student’s creativity and ability to organize
the answer.
❑❑ More stationery is needed.
❑❑ Permits a degree of guessing if precaution is not taken.
9.6. Objective Structured Clinical Examination

The objective structured clinical examination (OSCE) is a reliable approach to assess basic clinical skills
of a nursing student. Patient-based stations are used to conduct this test which differentiates it from OSPE.
At each station, students have to interact with a patient or a “standardized patient” to demonstrate specified
clinical skills. A standardized patient is a lay person who is trained to present patient problems realistically.
Chapter 11.indd 236 5/18/2012 11:50:31 AM

The stations may be short (5 minutes) or long (15–30 minutes) depending on the skills the student is asked
to demonstrate at a particular station. The number of stations may range from 8–20 depending upon the
availability of time and other resources. Scoring at each station is done with the help of a checklist or rating
scale by a faculty member. Each station requires a separate faculty to observe the students’ performances.
Planning of OSCE
Planning for OSCE should include determination of what clinical skills are to be tested at individual
stations and recruitment of real or standardized patients. Checklists are prepared as per the requirement
at each station. The number of stations has to be determined and accordingly faculty is assigned for each
station. OSCE generates a lot of data; for 100 students in a 20-station OSCE, there will be 2000 mark
sheets that require careful handling by the teachers.
Developing the Stations
Stem
Stem of the test item should be written in a standardized format for all the stations. For example, pa-
tient’s name, age, presenting complaints, and the settings (such as clinic, emergency, or ward) should
be written for all stations. The stem must clearly state the task which a student requires to perform, for
example, in the next 10 minutes conduct cardiac physical examination of the given patient.
Checklist
The checklist items should be clearly prepared for each station. It should include the steps of the observ-
able task which the students are asked to perform on a particular station. The length of the checklist
depends on the clinical task, the time allowed, and the scorer. A score must be assigned to every test item.
Items may be scored 1 or 0, or relative weights may be assigned with more critical items being worth more.
Limitations
❑❑ Time-limited stations often require students to perform isolated aspects of the clinical encounter
that may be unacceptable for formative assessments.
❑❑ OSCEs rely on task-specific checklists, which assume that the nurse–patient interaction can be
described as a list of actions.
❑❑ There are limits to what can be simulated and this constrains the nature of the patient problems
that can be sampled for OSCE.
10. EVALUATION OF ATTITUDE

Attitude is a dispositional readiness of an individual to respond to certain situations, persons or objects
in a consistent manner, which has been learned and has become one’s typical mode of response.
An attitude has a well-defined object of reference. For example, one’s views regarding the use of
condoms, performing mouth-to-mouth ventilation, cricket, and science are attitudes.
Methods of Scaling
Tests of attitudes are based upon several assumptions, which are as follows.
❑❑ The attitude scale should deal with a controversial question.
❑❑ An individual’s feelings and insights in relation to the question will determine his or her responses
to the various statements.
❑❑ The statements can be scaled in relation to the degree to which they are favored or opposed.
Chapter 11.indd 237 5/18/2012 11:50:31 AM

Measurement of Attitude
❑❑ One cannot see attitude directly; therefore, it has to be measured in an indirect way.
❑❑ Attitude can be measured from what the individual says or does.
❑❑ Attitudes refer to internal aspects of behavior, but there are external manifestations of attitudes as
they are expressed in actions.
❑❑ Actions may also express beliefs or feelings while performing a task.
❑❑ The most common approach in attitude measurement is to find out how favorable or unfavorable
is the individual to an idea.
Types of Attitude Scales

10.1. Thurstone Scales
Thurstone attitude scale is made up of statements about a particular issue and each statement has a nu-
merical value which indicates the respondent’s attitude, either favorable or unfavorable.
For constructing the Thurstone scale, statements are collected on the topic, capturing the attitudes
from favorable to unfavorable. Participants are asked either to give their ranking (1–11, where 1 is very
negative and 11 is very positive) for each item, or Q sort them in 11 piles. Participants are instructed to
indicate which statements they agree with and then the average response is computed. For example, on
the topic female feticide, the statements can be formulated as follows.
❑❑ There’s absolutely nothing wrong with it.
❑❑ It should be a sin.
❑❑ It should be against the law.
❑❑ It can alter sex ratio in the society.
❑❑ Those who already have one girl child can be allowed for this.
Before finalizing the scale, it is given to experts to provide their ranking for each item about their
suitability to be included in the scale. Those statements for which there is little consensus among experts
are discarded before administering the scale to students.
10.2. Likert Scale

A Likert (lick-curt) scale (named after its inventor Rensis Likert, 1932) is a psychometric scale com-
monly used in survey research, as well as to evaluate attitude of nursing students toward a controver-
sial issue or phenomenon of interest. It is a bipolar scaling method measuring either positive or nega-
tive response to a statement. It consists of Likert items that are statements about which the respondent
is asked to rate their level of agreement or disagreement. An individual’s score on a particular scale
is the sum of his ratings on all the items. This score reflects the respondent’s overall attitude toward
the issue in question. By dividing the total score by the number of items, the mean attitude score is
calculated.
Usually, a Likert scale is a symmetric scale because there are equal number of positive and nega-
tive statements. Often, five ordered response levels are used, although many psychometricians ad-
vocate using seven or nine levels because a five- or seven-point scale may produce slightly higher
mean scores relative to the highest possible attainable score as compared to those produced from a
10-point scale.
Chapter 11.indd 238 5/18/2012 11:50:31 AM

The format of a typical five-point Likert scale is as follows.

1. Strongly disagree.
2. Disagree.
3. Neither agree nor disagree.
4. Agree.
5. Strongly agree.
Likert scales may be subject to distortion from several causes. There may be problem of central
tendency bias, in which respondents may avoid using extreme response categories (strongly agree or
strongly disagree), social desirability bias, in which respondents try to portray themselves as socially
desired, acquiescence bias, which includes selecting items as they are presented. Designing a scale
with balanced keying (an equal number of positive and negative statements) can obviate the problem
of acquiescence bias, since acquiescence on positively keyed items will balance acquiescence on nega-
tively keyed items, but central tendency and social desirability are somewhat more problematic issues
associated with Likert scale.
Constructing Items for Likert Scale

❑❑ A large pool of potential items on a particular topic is prepared with the help of experts in the field.
Guidelines for Writing the Statements
❑❑ The statements should be brief.
❑❑ Each statement should convey one complete thought.
❑❑ The statement should belong to the attitude variable that is to be measured.
❑❑ The statements should cover the entire range of the affective scale of interest.
❑❑ Statements should be such that they can be endorsed or rejected (agree/disagree).
❑❑ Acceptance and rejection should indicate something about the attitude measured.
❑❑ Care should be taken for language of the statements.
– Avoid double negatives.
– Avoid “all, always, none or never”.
– Use “only, just, merely” with care.
– Avoid words with more than one meaning.
How to Improve the Likert Scale

❑❑ Group of judges is asked to score the statements.
❑❑ Sum the item scores given by the judges.
❑❑ Inter correlations between the paired items is calculated.
❑❑ Those items that have a low correlation between the summed scores are eliminated.
❑❑ Calculate average for the score of the top quarter and lowest quarter provided by the judges and do
a t-test of the means between the two. Eliminate questions with low t-values which indicate that
they have low discriminating power.
Given below is an example of a five-point Likert scale to measure the attitude of high-school students
toward basic life-support techniques.
Chapter 11.indd 239 5/18/2012 11:50:31 AM

ITEM RESPONSE SCORE
SA A ? SD D
1. Basic life-support should be learnt voluntarily by

every citizen of the country
2. If you encounter a person lying unresponsive, you
will immediately start basic life support
3. It is harmful to administer mouth-to-mouth
breathing with barrier devices
4. It is better to start chest compression instead of
no cardiopulmonary resuscitation, if you don’t
have barrier devices with you for mouth-to-mouth
ventilation
5. Government should install automatic external
defibrillators at all public places so that the number
of out-of-hospital deaths due to cardiac arrest can be
prevented
6. Basic life-support should be included in school
curriculum of secondary class students
7. Learning basic life support is not useful until we don’t
have nationwide uniform emergency medical service
(EMS) number
8. Fear of legal actions can hinder you to perform basic
life support
9. Basic life support should be strictly given by a
professional only
10. Basic life-support training for school children should
be adequate to prepare them for providing basic life
support
SA= Strongly Agree; A= Agree; SD= Strongly disagree; D= Disagree; ?= Uncertain
Reliability of the Likert scale

Likert scale measurements are at the ordinal level of measurement because responses indicate a ranking
only. As the numbers of scaling points are increased from 2 to 20, there is rapid increase in reliability but
it tends to level off at about 7, and after 11 points there is little gain in reliability of the scale (Nunally,
1978).
10.3. Guttman Scale

Guttman scaling is a method of scale construction developed by Louis Guttman in the year 1940. A
typical Guttman scale includes a series of items or statements tapping progressively higher levels of
a single attribute. In this attitude scale, the items are placed in order of low to high according to their
difficulty level so that approval of the any specific item in the list implies approval of all items prior
to that item.
Chapter 11.indd 240 5/18/2012 11:50:31 AM

10.4. Osgood’s Semantic Differential Scale

❑❑ It is another scale used to measure attitude.
❑❑ This scale has bipolar adjectives which are used to measure the reaction of participants to the is-
sue in question.
❑❑ Overall attitude score is obtained by summing across the individual item in the questionnaire
submitted by each respondent.
❑❑ The mean score is obtained by dividing the total score by the number of adjectives.
Sample of Semantic Differential Scale

Assessment of final-year students regarding their attitude toward patients
POSITIVE ADJECTIVES 7 6 5 4 3 2 1 NEGATIVE ADJECTIVES
Communicative Non-communicative
Polite Rude
Considerate Callous
Pleasant Unpleasant
Respectful Disrespecting
Friendly Insincere
11. SOCIOMETRY
Sociometry is an important evaluation tool for the assessment of behavior or attitude of a student toward
his or her classmates or group members. Jacob Moreno was the person who coined the term “soci-
ometry”. He conducted his famous sociometric study in the fourth decade at New York state training
school, New York. He defined sociometry as “the inquiry into the evolution and organization of groups
and the position of individuals within them.”
The word sociometry is derived from Latin words “Socius” and “Metrum” which means social mea-
sure. Therefore, sociometry is an instrument of social measure to know how much relatedness people
have with each other in a group. Measuring relatedness within a group is also helpful to assess behavior
of a person in the group. It shows the patterns of association among the group members while acting as
a group toward a specified end or goal. For a group leader sociometry may be helpful to identify group
conflicts and group cohesiveness among various group members so that appropriate interventions can
be planned for conflict resolutions and to improve communication among group members.
The underlying assumption of sociometry is that people make preferences in interpersonal relation-
ships. Whenever a person joins a group, he makes preferences like with whom to sit or stand; with
whom to talk or not, and so on. These choices are made on the basis of some criteria that may be subjec-
tive or objective. The subjective criteria may include feelings of likes and dislikes about a person on first
interaction. The criteria may be objective, such as knowing that a person does or does not have certain
qualities needed for the particular group task.
When everybody in a group is asked to choose other group members on the basis of some speci-
fied criteria, everyone will make his or her own choices and will have justification for why they have
chosen someone on the basis of given criteria. These choices of group members give rise to a network
within the group. A map, constructed with the help of these networks is termed as a sociogram, which
Chapter 11.indd 241 5/18/2012 11:50:31 AM

TABLE 11.1 Sociomatrix

Shivani Sandeep Suman Sushmita
Shivani + – O
Sandeep + O +
Suman – O +
Sushmita O – –
shows the direction of the relationship between the group members, which may be uni-directional,
bi-directional or neutral. The data of the choices made by the group members may also be displayed as
a table or matrix of each person’s choices, which is termed as sociomatrix.
For example, a class teacher of four M. Sc Nursing students wants to know how much interpersonal
conflicts exist between the students. The names of students are Sandeep, Suman, Sushmita and Shivani.
A criterion for this example is, “what is your level of trust to share your feelings with each of them about
issues at the clinical area?”
+ = High Trust
O = Moderate Trust
– = Distrust/Conflict
Students are interviewed after assuring them that the responses will be kept confidential. Let us see how
Shivani has rated the rest of the three members.
Sandeep +
Suman –
Sushmita O
The choices made by Shivani can be interpreted as she has high trust in Sandeep, moderate trust in
Sushmita and is in conflict with Suman. Similarly, the responses collected from each group member can
be plotted in a table known as sociomatrix which is shown in Table 11.1.
From Table 11.1, it can interpreted that Sandeep is the informal group leader as she received maxi-
mum +, Sushmita is isolated from the group as she received maximum -. Suman and shivani are in
negative mutual relations as both of them rated each other negative. Similarly Sandeep and Shivani are
in positive mutual relationship.
Sociometry has been proven to be a valid tool for the assessment of group behavior in a classroom so
that teachers can exercise corrective strategies for those who are in conflict situations to improve their
group behavior.
12. ITEM ANALYSIS

It is the process of evaluating a single test item by determining its difficulty level, discriminating index
and distracter effectiveness. It is done after a test has been administered and scored, but before the
results are announced. Item analysis is a process which examines student responses to individual test
items in order to assess the overall quality of the items as well as of the test as a whole. It is especially
valuable to improve test items for future use.
Chapter 11.indd 242 5/18/2012 11:50:31 AM

Process of Item Analysis

The process of item analysis focuses on the following.
1. The difficulty of the item (difficulty index or facility value).
2. The discrimination power of the item (discrimination index).
3. The effectiveness of each alternative (distracter functionality or effectiveness).
Difficulty Index
The difficulty level of a test paper is determined by the difficulty level of the individual questions/items
in the paper. The item difficulty index ranges from 0 to 100; the higher the value, the easier the ques-
tion and vice-versa. It also plays an important role in the ability of a test item to discriminate between
students who know the test material and those who do not. The item will have low discrimination if it is
so difficult that almost everyone gets it wrong or guesses, or so easy that almost everyone gets it right.
Single Response Questions
1. The difficulty index of a question is equal to the percentage of students who correctly answer the
question out of those who attempted the question.
2. This Index will be higher for questions that are easy and lower for questions that are difficult.
3. This index is also known as facility index.
The Steps in the Calculation of the Difficulty Index
1. The answer sheets are arranged in order of the highest score to the lowest score.
2. The papers of the top 27 percent (in terms of the “score”) of the students, and the bottom 27 percent
of the students are selected. For convenience, one may choose the highest and lowest quarters of
the students by their score. Where the highest and lowest 27 percent each exceed 100, it would be
enough to select the highest 100 and lowest 100 papers.
3. The number of students who have responded correctly to each question is counted from the two
groups of papers chosen in step 2.
4. The number of students who respond correctly to the question in the two groups is added and ex-
pressed as a percentage of the total number of students in the two groups. This gives the “difficulty
index” of each question.
H+L
Thus difficulty or facility index = ×100
N
Where H = Number of correct responses in the upper group
L = Number of correct responses in the lower group
N = Total number of responses in both groups
The ideal difficulty index should be between 50 and 60 percent. Such a test is very likely to be reliable
with higher internal consistency. Questions with difficulty indices in the range of 30–70 percent are
considered to be satisfactory. Given below are ideal difficulty indices for different formats of MCQs.
Format Ideal Difficulty Index
Five-response multiple-choice 70
Four-response multiple-choice 74
Three-response multiple-choice 77
True–false (two-response multiple-choice) 85
Chapter 11.indd 243 5/18/2012 11:50:58 AM

Discriminating Index
Item discriminating index is calculated by comparing the number of students in the upper and lower
groups who get the item right. For example, six students out of ten in the upper group and two students
in the lower group out of ten select the correct answer. It indicates positive discrimination since the item
differentiates between students in the same way that the total test score does.
An index of discrimination can be easily computed. Simply subtract the number in the lower group
who got the item right from the number in the upper group who got the item right and divide it by the
number in each group. Thus, for our sample item, the computation would be as following:
6−2
Index of Discrimination = = 0.40
10
Maximum positive discriminating power is indicated by an index of 1.00. This is obtained only
when all students in the upper group select the correct answer and no one in the lower group does. Zero
discriminating power (0.00) is obtained when an equal number of students in both groups get the item
right. A test item is labeled as having negative discriminating power when more students in the lower
group than in the upper group get it right. Both types of items should be removed from general achieve-
ment tests.
Distracter Effectiveness
Effectiveness of the distracters is determined by comparing the number of students in the upper and
lower groups who selected each incorrect alternative. A good distracter will attract more students from
the lower group than the upper group. Distracter effectiveness analysis is useful in evaluating a test item
to improve it.
Chapter 11.indd 244 5/18/2012 11:51:01 AM

CHAPTER HIGHLIGHTS
❑❑ A standardized test is one that is administered under standardized or controlled conditions.
Controlled conditions mean that date, time and settings of the test are same for all the students.
The construction and administration of the test is technically sound.
❑❑ Non-standardized tests are those which do not follow the rules of standardized tests and in which
there is no uniformity in the students’ evaluation. Questions are varied for different students or the
test items are not standardized.
❑❑ Any test which fulfills certain criteria is termed as good test because it ensures uniformity of the
evaluation across all students. These criteria are validity, reliability, objectivity and usability.
❑❑ Validity is the judgment made about a test’s ability to measure what it is intended to measure. It re-
fers to the appropriateness, meaningfulness and usefulness of inferences made from the test score.
❑❑ Content validity refers to the validity of the content of the test items; also it refers to the extent
to which the test items are representative of all possible items on the particular topic of interest.
❑❑ Construct validity means the test items are measuring the construct of interest not any other simi-
lar construct.
❑❑ Criterion validity refers to the relationship of a score on one measure (the test prepared by you)
to other external measures. There are two types of criterion validity: concurrent criterion validity
and predictive criterion validity.
❑❑ The internal validity of a test is the extent to which it measures what it is supposed to measure.
The external validity of a test refers to how well it can be generalized to the target population for
which it was developed.
❑❑ A test is said to be reliable when it constantly measures a given performance in the same way on
repeated testing.
❑❑ Essay type questions are such questions which require students to write answers in essay format
in their own words resulting in different patterns of answers for a particular question, which are
subsequently judged by an expert subjectively. Such questions are aimed to assess the synthesis,
application, analysis and other higher domains of cognitive abilities as well as writing, organizing
and expressive skills of the student.
❑❑ Short-answer questions are open-ended questions which require responses of one word or few
sentences. They are slightly less structured as compared to MCQs and more structured as com-
pared to essay type questions.
❑❑ MCQs are special type of questions which are widely used in various entrance exams where thousands
of students attempt the exams. These are standardized type of test with high reliability and validity.
❑❑ Observation checklist is a two-dimensional tool used to assess and record the presence or absence
of behavior, trait or activity when an incident occurs.
❑❑ Rating scale is a device which facilitates appraisal of number of traits or characteristics in relation
to a common qualitative scale of values.
❑❑ Anecdotal record may be defined as a factual record of an observation of a single, specific and
significant event in the behavior of a student. It is a verbal snapshot of an incident.
❑❑ OSPE (objective structured practical examination) is a technique of evaluating skill of students
where students are given a specific question on the skills to be tested and asked to demonstrate
the desired skills in a given time by going through different stations in an orderly manner. The
students are awarded scores in proportion to the competency level demonstrated by them.
Chapter 11.indd 245 5/18/2012 11:51:01 AM

❑❑ An attitude is a dispositional readiness to respond to certain situations, persons or objects in a

consistent manner, which has been learned and has become one’s typical mode of response.
❑❑ Osgood’s semantic differential scale has bipolar adjectives, which are used to measure the reac-
tion of participants to the issue in question.
❑❑ Item analysis is the process of evaluating a single test item by determining its difficulty level,
discriminating index and distracter effectiveness.
❑❑ The difficulty index of a question is equal to the percentage of students who answer a question
correctly from among those who attempted the question.
EVALUATE YOURSELF
Q 1: How will you ascertain the validity, reliability and objectivity of a test? (AIIMS, 2006)
Q 2: Explain one of the tools used to assess the clinical competence of students. (AIIMS, 2006)
Q 3: Write short note on anecdotal record. (AIIMS, 2006)
Q 4: Write a short note on improving assessment through essay type questions. (AIIMS)
Q 5: How will you frame good MCQ? Give examples of MCQs. (BFUHS, 2008)
Q 6: Write a short note on OSPE. (NIMS, 2010)
Q 7: What are the different methods of evaluation of skills?
Q 8: Write a short note on item analysis. (MGRUHS, 2008)
Q 9: List the advantages and disadvantages of essay type questions and MCQs. (RGUHS 2009, 2010)
Q 10: Differentiate between checklist and rating scale. Give an example of checklist and rating scale.
(MGR, 2008, 2009)
1. Lambert WT, Schuwirth and Cees P M van der Vleuten. ABC of learning and teaching in medicine:
Written assessment. BMJ 2003;326;643–5.
2. Sydney Smee. ABC of learning and teaching in medicine: Skill based assessment. BMJ
2003;326;703–6.
3. Ebel RL, and Frisbie, DA (1986). Essentials of Educational Measurement (4th ed.). Englewood
Cliffs, New Jersey: Prentice-Hall.
4. Haladyna, Thomas M (1997). Writing test items to evaluate higher order thinking. Needham
Heights, MA: Allyn and Bacon.
5. Jacobs, LC, and Chase, CI (1992). Developing and using tests effectively: a guide for faculty. San
Francisco: Jossey-Bass.
6. Linn, RL, and Gronlund, NE (1995). Measurement and Assessment in Teaching (7th ed.). Upper
Saddle River, New Jersey: Prentice-Hall.
7. Payne, D (1992). Measuring and Evaluating Educational Outcomes. New York: Macmillan.
8. Stalnaker, Zeidner, M (1987). Essay versus multiple-choice type classroom exams: the student’s
perspective. Journal of Educational Research, 80 (6), 352–8.
9. Brown, G with Bull, J and Pendlebury, M (1997). Assessing Student Learning in Higher Education.
London: Routledge.
Chapter 11.indd 246 5/28/2012 2:19:14 PM

10. Gronlund, NE (1988). How to construct Achievement Tests. Englewood Cliffs: Prentice Hall.
11. Isaacs, G (1994). “About multiple choice questions” in Multiple Choice Testing: Green Guide, No.
16, HERDSA, Cambelltown, NSW, 4–22.
12. McBeath, RJ ed. (1992). Instructing and Evaluating Higher Education: A Guidebook for Planning
Learning Outcomes. New Jersey: ETP.
13. Owen, SV and Freeman, RD (1987). “What’s wrong with three option multiple items?” In Educa-
tional and Psychological Measurement 47, 513–22.
14. Hale, Ann E (1985). Conducting Clinical Sociometric Explorations: A Manual. Roanoke, Virginia:
Royal Publishing Company.
15. Hollander, Carl E (1978). An Introduction to Sociogram Construction. Denver, Colorado: Snow
Lion Press, Inc. Available at the Colorado Psychodrama Center, 350 South Garfield, Denver CO,
303-322-8000.
16. Moreno, Jacob Levy (1960). The Sociometry Reader. Glencoe, Illinois: The Free Press.
17. Northway, Mary L (1967). A Primer of Sociometry. Toronto: University of Toronto Press.
18. William T Branch. Use of critical incident reports in medical education: a perspective. J Gen Intern
Med. 2005 November; 20(11): 1063–7.
Chapter 11.indd 247 5/18/2012 11:51:01 AM

c h a p t e r 12
Curriculum Development
1. INTRODUCTION
Curriculum may be equated with the ground which is covered by the student and teacher together
to reach educational goals. Popularly, it is known as the “syllabus” or the “course” of the taught in a
school, college or university. It is the totality of the learning experiences a student gets during an educa-
tional programme or in other words it includes all the teaching- learning activities planned by a teaching
institution to achieve desired goals of an educational programme.
2. MEANING AND DEFINITION

Curriculum word is derived from the Latin language which means a course of deeds and experiences
through which children grow to become mature adults. Oliva (1997) has explained the meaning of cur-
riculum as the following:
❑❑ It is a course of study or a set of subjects or set of performance objectives or a program of studies.
❑❑ It is everything that goes on within the school, including extra-class activities, guidance, and
interpersonal relationships.
❑❑ It is everything that is planned by the school personnel.
❑❑ It is a series of experiences undergone by learners in a school.
Cunningrow defined curriculum as a tool in the hands of the artist (teachers) to mould his material
(the pupil) in accordance with his ideals (aims and objectives) in his studio (school).
Grundy (1987) defined curriculum as a programme of activities carried out by the teachers and pupils
so that pupils will attain certain educational and other schooling ends or objectives.
Stenhouse (1975) maintained that “curriculum is an attempt to communicate the essential principles
and features of an educational proposal in such a form that it is open to critical scrutiny and capable of
effective translation into practice.”
Kerr (1968) argued that “curriculum has all the learning activities which are planned and guided by
the school, whether they are carried out in groups or individually, inside or outside the school.”
Jeffs and Smith (1999) argued that the curriculum is the central dividing line between formal and in-
formal education. Curriculum only makes sense when considered alongside notions like class, teacher,
course, lesson and so on. It is not a concept that stands on its own.
Curriculum is a systematically arranged plan of learning experiences, teaching strategies, evaluation
or examination criteria and other extracurricular activities developed by a school for a defined group of
students to attain the aims of a particular educational programme.
Chapter 12.indd 248 5/18/2012 11:52:59 AM

Curriculum Development | 249
In many educational circles curriculum is still equated with a syllabus. Curzon (1985) and Blenkin
(1992) argued that an approach to curriculum theory and practice which focuses on syllabus is only
really concerned with content. Therefore, curriculum is a body of knowledge-content and/or subjects.
Education in this perspective is the process by which these are transmitted or ‘delivered’ to students by
the most effective methods that can be devised (Blenkin et al 1992).
3. PURPOSES OF CURRICULUM
Curriculum is an essential tool in the hands of educators to guide a course of study that serves some
distinct purposes which are as follows:
❑❑ It communicates to the students in advance what they are expected to learn in the specified time
duration to accomplish their educational goals.
❑❑ It introduces the criteria of examination or evaluation to the students so that they can prepare for
exams accordingly.
❑❑ It describes to the teachers the course, unit and lesson objectives as well as required teaching
learning methods, which assists the teachers to plan their lesson accordingly.
❑❑ It communicates to the policy makers about the competencies and expertise of a particular group
of students the positions and roles they can perform.
❑❑ It prepares the pupil for citizenship in a democratic society.
❑❑ It meets the needs of students with a wide range of ability, aptitudes and interests.
❑❑ It relates and systematically organizes the various learning experiences so as to produce the maxi-
mum cumulative effect in attaining the objectives of the school.
4. TYPES OF CURRICULUM
Although, there is no universally acceptable classification of curriculum, educationists however
have classified it on various basis. The available literature suggested the following classification of
curriculum:
4.1. Core Curriculum

Core curriculum is a course of study, which is considered central and usually made mandatory for all
students of a college or university. It is also referred to key aspects of a discipline for study in depth by
all the students. For instance, in M Sc Nursing course the advance nursing practice, research and statis-
tics, nursing administration or management is part of the core curriculum which is considered manda-
tory for all M Sc Nursing students irrespective of their specialty area.
4.2. Open Curriculum

Open curriculum is a type of curriculum which a student volunteers to choose according to his aspira-
tion and motivation. For example, Cardiological and CTVS nursing, Oncology nursing and Psychiatric
nursing are open curriculum for M Sc nursing course because a postgraduate aspirant choose these
courses as per their motivation. Open curriculum approach respect college students the right to choose
what courses they want to opt for as per their interest.
Chapter 12.indd 249 5/18/2012 11:52:59 AM

4.3. Explicit (Expressed) or Overt or Written or Official Curriculum

Explicit curriculum is one which is expressed or written in curriculum document as well as teachers plans,
which is well informed to both teachers and students. It is usually confined to those written understand-
ings and directions which are formally chosen and reviewed by the curriculum committee and teachers.
4.4. Implicit (Or Hidden) Or Covert Curriculum

Implicit curriculum as opposed to explicit curriculum is not expressed or appears in official documents
and teacher’s plan as well as it is not informed to the students. It refers to the kinds of learning, student
derive from the nature and organizational design of the school or college of nursing, as well as from the
behaviors and attitudes of teachers and administrators (Modified from the Longstreet and Shane, 1993)
According to Vic Kelly (1988) hidden curriculum includes those which students learn, ‘because of the
way in which the work of the school is planned and organized but those which are not in themselves overt-
ly included in the planning or even in the consciousness of those responsible for the school provisions.
4.5. Null Curriculum

The null curriculum is something which is not taught in the school or college, thus giving students the
message that these elements are not important in their educational experiences or in the society. Not
teaching some particular sets of ideas may be due to mandates from higher authorities, or to deeply
ingrain assumptions and biases.
Eisner (1994) expressed his views on null curriculum “that what schools do not teach may be as im-
portant as what they do teach. I argue this position because ignorance is not simply a neutral void; it has
important effects on the kinds of options one is able to consider, the alternatives that one can examine,
and the perspectives from which one can view a situation or problems.”
4.6. Societal Curriculum

Cortes (1981) defines societal curriculum as the massive, ongoing, informal curriculum of family, peer
groups, neighborhoods, churches organizations, occupations, mass, media and other socializing forces
that “educate” all of us throughout our lives. It is planned by social groups outside of an educational
institution and is more concerned with the general characteristics of curriculum content.
4.7. Institutional Curriculum

Institutional curriculum is planned by the nursing faculty at college level for a clearly identified group
of nursing students who will spend a specified time period in that nursing institution.
4.8. Instructional Curriculum

It consists of the content planned for routine instructions in theory classes as well as in clinical and com-
munity area by the teacher for a specified group of students to achieve the desired behavioral changes
in the student.
4.9. Integrated Curriculum

The integrated or fused curriculum is the curriculum in which the concepts, phenomena, and processes
etc. from different subjects are blended together. For example, Medical Surgical Nursing is an inte-
grated subject/curriculum representing pathology, microbiology, medicine, surgery etc.
Chapter 12.indd 250 5/18/2012 11:52:59 AM

Intergrated
Curriculum
Institutional Instructional
Cirriculum Curriculum
Societal Open
Curriculum Curriculum
Types of
Curriculum
Null Core
Implicit/Covert Explicit/Overt
Figure 12.1 Types of Curriculum
5. PRINCIPLES OF CURRICULUM
Following are the principles of curriculum design for general as well as professional education.
5.1. Principle of Utility

It emphasizes that curriculum should equip a student with knowledge and skills so that he can solve
problems and face situations confidently in real life. It should help the individual to avail his rights as a
consumer & get the standard quality of service at the right price.
5.2. Principle of Flexibility

This principle takes into consideration the uniqueness of every individual student. It emphasizes that
curriculum should be flexible enough to accommodate the changes in the student’s diverse interest,
inclinations & accordance with social requirements.
5.3. Principle of Community-Centeredness

The needs and problems of the community should be given priority in the curriculum development. A
good curriculum should cater to the community needs at local as well as national level, so that; students
can be prepared to tackle these community problems.
Chapter 12.indd 251 5/18/2012 11:52:59 AM

5.4. Principle of Activity-Centeredness

Learning through purposeful activity and actual life experiences makes learning process interesting
long lasting and enjoyable. Therefore, curriculum development should focus on those experiences
which lead to active learning among students.
5.5. Principle for the Use of Leisure

The curriculum should teach the student how to use leisure time wisely because the use of leisure time
in an appropriate manner develops creativity, aesthetic sense and vocational skills among students.
5.6. Principle of Development of Culture and Civilization

The pupil should have the knowledge of their culture and civilization, therefore; curriculum should
include these aspects which are necessary to be a good citizen.
5.7. Principle of Need Based Activity

It caters to the needs of society & provides the manpower for social and economic development of the
Nation.
5.8. Principle of Value-Orientedness

For the inculcation of values like social justice, equality of opportunity, equality of sexes, social and
democratic values among the learners curriculum should be value oriented.
5.9. Conservative Principles

Conservations of cultural heritage, monuments, natural resources, wildlife should be inculcated in a
student to make him a responsible citizen of the nation.
5.10. Principle of Harmony

Formal & Informal education, individual and social aims should be interwoven into a harmonious whole
paving the way for the overall development of the individual & social up-liftment.
6. FORCES & ISSUES INFLUENCING CURRICULUM DEVELOPMENT

Forces & issues that influence nursing science curriculum are complex and ever changing. In the new
millennium, there are rapid changes within the health care system which puts forth challenges before
nurse educators to device relevant curriculum for nursing education to keep pace with these changes.
Curriculum is never developed in a vacuum, but in contextual representation of global trends, national
vital and health statistics, national health policy, national population policy, professional priorities &
faculty values. The following are the determinants of the curriculum in nursing sciences:
6.1. Societal Determinants

6.1.1. Demographic Revolution
World population is growing at an unprecedented rate and has exceeded 6 billion. There will be more
health problems associated with the elderly, as a result of the ageing population in the next 20-30 years.
Chapter 12.indd 252 5/18/2012 11:52:59 AM

Demographic changes are also prompting mass urbanization, immigration to rich countries, shift to the
age structure towards elderly and paucity of resources due to increasing population.
Curriculum Implications: These demographic changes have emphasized promotion of health and
prevention of diseases, disabilities as well as chronic illnesses. There is a dire need of increased number
of nurses due to the growing population therefore; more nursing educational programmes should be
made available through distance education, curriculum should include components of geriatric nursing.
6.1.2. Major Health Problems

There is a shift of major health problems towards chronic disabilities, psychiatric or psychological prob-
lems, swine flu, bird flu which should be given due consideration in the nursing curricula.
6.1.3. Advancement in Medical Technology

Medical technology has become more complex and sophisticated with the technical advancement in ba-
sic sciences therefore; it is more relevant to device more continuing educational programmes for nurses
to keep pace with the fast growing medical technology.
6.1.4. Change in Health Care Delivery System

More emphasis is on preventive aspects of the care, primary health, community health, and ambulatory
care which demands for adequate representation in curriculum.
6.1.5. Cultural Diffusion & Family Disintegration

Nuclear family and cultural diffusion has given rise to numerous problems like drug addiction, alcohol-
ism, pre-marital sex and emergence of AIDS which necessitates modifications of curriculum to take in
to consideration these emerging health problems in society.
6.1.6. Changes in Patient’s Expectations

Increased cost of health care has heightened the expectations of patients in terms of quality of care
and satisfaction. Patient’s bill of rights has increased the accountability of nurses in all the health care
settings. These changes in patient expectations have implications for evidence based teaching and in-
troduction of quality assurance model, practice standards and code of ethics into the nursing curricula.
6.2. Educational Determinants

6.2.1. New Educational Strategies
Varieties of educational strategies which are appropriate for adult learning have come into being. Com-
puter as an aid to teaching is useless without software design to support learning in the nursing pro-
fession. Programmed instructions, objective based education, competency based curriculum, problem
based education, computer assisted instruction are some of the innovations in nursing education which
require a radical transformation of the curriculum, furthermore, the content materials need to be devel-
oped by the nursing experts to justify the curriculum transformation. These factors also have curriculum
implications in terms of self directed learning, development of self instructional module etc.
6.2.2. New Methods of Assessment

Objective structured clinical evaluation (OSCE) and Objective structured practical examinations (OSPE)
are the innovative evaluation strategies which have implications for newer design of nursing curriculum.
Chapter 12.indd 253 5/18/2012 11:52:59 AM

6.3. Economical Determinants

It involves cost benefits analysis to determine the suitability of a nursing programme. Curriculum com-
mittee should analyze whether the programme is cost effective or not?
6.4. Philosophical Determinants

The school of philosophy in which the profession or society or nations believes, influence the contents
of the curriculum as well as the instructional strategies employed to achieve objectives of the education.
7. CURRICULUM DEVELOPMENT
Print (1993) defines curriculum development as, “the process of planning, implementing and evaluat-
ing learning opportunities intended to produce desired changes in learners.” A curriculum development
model is used to study the components of a curriculum and the relationships between these components.
It is a symbolic representation of the relationships between specified curriculum development phases,
steps and tasks that constitute a curriculum development process.
Curriculum development should involve decision making about the foundations and structure of a
curriculum which refers to the various components of a curriculum (aims/goals/objectives, content,
learning activities and evaluation). Curriculum development is a logically sequential and orderly pro-
cess which includes certain steps into a predetermined sequence. These steps are as follows:
❑❑ Constitution of a curriculum committee
❑❑ Investigation & analysis of the existing health needs of the region & nation (For e.g. National
Health Policy, 2005)
❑❑ Investigation of curriculum needs for nursing education
❑❑ Formulation of the philosophy of nursing education
❑❑ Establishment of educational objectives/outcomes/ competencies
❑❑ Selection of learning experiences
❑❑ Selection of instructional strategies
❑❑ Organization of learning experiences
❑❑ Development of Evaluation systems
The curriculum committee established by the Indian nursing council or any university or institution
determines the health needs of the region as well as the nation, by analyzing the national health statis-
tics, national health policy document, national population policy document and other related documents
which are of interest. In the light of the results of the analysis the curriculum committee determines
the need of a particular nursing educational programme. While developing curriculum for any nursing
education programme the committee follows certain steps which are as follows:
7.1. Formulation of Philosophy of Nursing Education Programme

Philosophy means love of wisdom. It is the most influential determinant of the curriculum development
which provides directions to the entire process of curriculum development. The philosophical bases of a
curriculum refer to the underlying values and beliefs that influence the curriculum structure and its sub-
stance. Any decision that educators make about a curriculum is influenced by their philosophical assump-
tions about the epistemology (the nature of knowledge), society/culture, the individual (specifically the
learner) and learning (how a person learns and what learning theories the curriculum should be based upon).
Chapter 12.indd 254 5/18/2012 11:52:59 AM

TABLE 12.1 Differences between Philosophy and Education

Philosophy Education
Philosophy sets the goals It provides means to achieve them
Philosophy is the wisdom It transmits this wisdom to the students
Ideals, values, principles are derived from the Education works out these ideals, principles and
philosophy values for the students
Philosophy determines contents of curriculum Curriculum contents are covered in a course
through education
Aims of education determined by Philosophy Aims of Education are achieved through teaching
and learning activities
Given below are the Philosophical assumptions which affect the process of curriculum development
❑❑ Philosophical Statement
Example 1: “We believe that the Post Graduate course in nursing should prepare nurses for lead-
ership level positions in nursing both in the hospital and the community settings”.
Curriculum Implications:
1. The curriculum should provide for experience in all major clinical areas of nursing sciences in the
hospital as well as in the community.
2. The curriculum should emphasize development of leadership qualities among postgraduate nursing
students.
3. Facilities should be provided to put these principles into practice.
Example 2: “We recognize that nursing is a profession, which is influenced by advances in
science and medical technology”.
❑❑ Curriculum Implications
1. There should be periodic evaluation of the total curriculum and continuous evaluation of its differ-
ent parts.
2. Need based continuing education programmes should be developed at various level and also curricu-
lum should focus on the concept of continuing education, in-service education and staff development.
For the formulation of philosophy of an educational programme the curriculum committee should hold
discussions and identify areas to make statements on the political, social, economic and other grounds
for the development of curriculum.
7.2 Education Objectives

Philosophical assumptions direct the development of educational objectives. In the traditional approach
of curriculum development, content is derived first and thereafter objectives are determined, on the
Chapter 12.indd 255 5/18/2012 11:52:59 AM

Standard Monitor Identify

curriculum outcome the needs
Specify Specify
evaluation professional tasks
Curriculum
strategies
Development
Process
Determine
Frame
teaching
objectives
learning
strategies
Select
content
Figure 12.2 Curriculum Development Process
contrary, in objectives based education which recently has gained much popularity in nursing sciences,
educational objectives are determined before the development of a course content.
Education objectives are the statements of those desired changes in a student’s behavior result-
ing from the specific teaching learning activity. It determines the final outcomes of an educational
programme. Educational objectives should be relevant, unequivocal, logical, achievable, feasible and
measurable.
7.2.1. Determinants of Educational Objectives

❑❑ Statement of School’s Philosophy
❑❑ Social & Health needs of the society
❑❑ Types of services provided to the patient (preventive, promotive and curative)
❑❑ Level of the professional competence to be attained
❑❑ Student’s background, level of education before entering into a training programme
❑❑ Statutory minimum requirements
❑❑ The teaching, physical and clinical resources available
❑❑ Future demands on nursing profession in relation to advancements in technology
❑❑ Expected job responsibilities of different nursing positions
7.2.2. Importance of Educational Objectives in Curriculum Development

❑❑ Serves as a guide in selection of important and desirable subject content
❑❑ Describes behavior in terms of student performance
❑❑ Indicates direction towards which the behavior of the student is to be geared
❑❑ Serves as a basis for evaluation (to what extent the objectives have been achieved)
❑❑ Provides direction to the students towards in depth study
Chapter 12.indd 256 5/18/2012 11:53:00 AM

❑❑ Helps in evaluation of the course and gives feed back to planners, administrators and others con-
cerned about the efficacy of the educational programme.
In many educational circles of nursing sciences there is a move from objective based education to out-
come based education. In outcome based education there is a move from the “How” and “When” to the
“What” and “Whether” of education. An outcome is something that follows as a result of consequence.
In this approach of curriculum development terminal objectives are re-titled as outcomes.
Characteristics of outcomes based Education

❑❑ Outcomes are clearly identified
❑❑ Achievement determines progress
❑❑ Multiple instructional strategies and authentic assessment tools are used
❑❑ Students are given time and assistance to reach their potential
Outcomes are general statements that refer to characteristic graduates must acquire by the end of the
programme or outcomes may be viewed as core characteristics or those qualities which faculty want
graduates to display.
Key Components of outcome based objectives

Exit outcome
❑❑ The student will be able to diagnose and manage patients with acute coronary syndrome
Intermediate outcome
❑❑ The student will be able to take cardiac history of a patient
❑❑ The student will be able to perform cardiac physical examination of the patient
Introductory Outcome
❑❑ Student will be able to describe overview of physiology with reference to relevant anatomy of the
cardiovascular system.
8. FOUR KEY COMPONENTS OF EDUCATIONAL OBJECTIVES

The four key components of educational objectives are: Act, Content, Condition and Criteria.
For instance, list anatomical pathway related to normal conduction of impulse in heart as stated in
Wood’s cardiac nursing. The four key components in this example are as following:
The Act - To list
The Content - The anatomical pathways related to heart impulse conduction
The Condition - Normal conduction
The Criteria - As stated in Wood’s Cardiac Nursing
Limitation of Educational Objectives

❑❑ May lead to surface learning
❑❑ Students have little understanding of why they have to learn the material other than to pass the
examination.
Chapter 12.indd 257 5/18/2012 11:53:00 AM

Condition
Key component of
Criteria educational Act
objectives
Content
Figure 12.3 Key Components of Educational Objectives
TABLE 12.2 omparison of Skill Beck (1987) and Quinn (1997) Curriculum
C
Development Models
Situational analysis model of Quinn ‘s (1997) stages of Task included in the stages
curriculum development curriculum development
(Skill Beck, 1984)
Situational analysis Exploratory stage Analysis of the existing situations
and the culture
Goal setting Design stage Aims and Objectives (Learning
Outcomes)
Programme building
Course content, Learning
resources
Teaching learning methods/
strategies
Assessment (summative and
formative)
Interpretation and Implementation Implementation of the course
implementation of study
Monitoring, feedback, Monitoring and review Evaluation of the programme
assessment, reconstruction
Chapter 12.indd 258 5/18/2012 11:53:00 AM

9. SELECTION OF LEARNING EXPERIENCE

Learning experiences refers to deliberately planned experiences in selected situations where students
actively participate, interact which results in desirable changes in behaviour of students (learning). It
refers to the interaction between learner and the external conditions in the environment which results in
modification in behaviour of the learner.
Selection of learning experience is concerned with decision about the content of theoretical sub-
ject matter, clinical, community and laboratory practices. Both direct and indirect learning experiences
should be planned as per the requirement and the available resources on hand.
9.1. Criteria for the Selection of Learning Experience

❑❑ Learning experiences selected should be consistent with and lead to the achievement of terminal
goals.
❑❑ Learning experiences should be varied and flexible.
❑❑ Learning experiences should provide opportunity to practice and develop skills.
❑❑ Learning experiences should be adapted according to the needs of students so that they can attain
learning satisfaction.
❑❑ Selected learning experiences should be given appropriate weightage as per the need of the course.
(Refer fig 12.1)
9.2. Principles for Selecting Learning Experiences

❑❑ Clearly relate to the desired objectives/ competencies, learning domain and domain level. Learn-
ing experiences should be purposeful, planned and organized.
❑❑ Should be appropriate for the cognitive, affective or psychomotor development of the students.
❑❑ Be sufficiently challenging so that they move students to higher levels of cognitive and affective
development.
❑❑ Be emotionally satisfying for students.
❑❑ Learning experiences should be a means for acquiring the expected overall professional develop-
ment of the students.
❑❑ Should be representative of the type of activity in which professional nurses engage.
❑❑ They should be sufficiently varied to prevent boredom, allow for and exploit the potential for
individual student differences.
❑❑ Learning experiences should also enable students to participate in some trans-cultural experience.
❑❑ Articulate and allow application of some previous learning experiences within the same course as
well as experiences from previous and concurrent courses.
❑❑ Learning experiences should provide a foundation necessary for subsequent learning.
❑❑ Permit faculty to guide and monitor the students practice when appropriate.
9.3. Organization of Learning Experiences

It is the systematic arrangement of learning experiences, so as, to increase the cumulative impact of
many individual learning experiences. The cumulative experiences provide for greater depth in learn-
ing. They help the students to integrate learning meaningfully as well as prevent assimilation of knowl-
edge in a defragmented or disjointed manner.
Chapter 12.indd 259 5/18/2012 11:53:00 AM

80% student
must know or
20% desirable to learn it also know
know or learn it as core curriculum
10% it is nice
if, student
know or
learn it
Figure 12.4 Percentage Distribution of Learning Experiences in Curriculum
9.4. Principles of Organization of Learning Experience

The organization of learning experiences should be based on some principles which are as follows:
❑❑ Principle of continuity
❑❑ Principle of sequence: Learning experiences should be placed in an order that leads to gradual
progress. The following criteria can be used to place them in order
❑❑ Simple to complex
❑❑ Concrete to abstract
❑❑ Normal to abnormal
9.5. Integration and Co-ordination

Learning experiences should be integrated and coordinated in such a way so as to create a state of
wholeness, harmony and relatedness.
Types of Integration
Vertical Integration: Co-ordination between disciplines traditionally taught and different structure and
functions of a system (e.g. circulation) and system malfunction (myocardial infarction).
Horizontal integration (parallel discipline): It means two or more department teaching concurrently
merge their educational identities and organize their teaching programme e.g. cell could be taught in a
much better format if integrated horizontally.
When the learning experiences are organized and placed under the subject headings then a plan is
decided to distribute these subjects in the context of overall curriculum, the principles of sequence and
integration are to be observed again in this stage. For instance, psychology is placed in B Sc nursing 1st
year followed by psychiatric nursing in the 2nd year.
9.6. Organization of Clinical Learning Experiences

Clinical learning experiences are organized through the rotation plans.
Chapter 12.indd 260 5/18/2012 11:53:00 AM

9.6.1. Rotation Plan

Rotation refers to regular successive recurrent posting of various groups of students belonging to differ-
ent levels of learning (different classes) in clinical Field.
Master rotation plan is an overall plan of rotation of all the students in a particular education institu-
tion showing the placement of the student belonging to various groups/ classes in clinical nursing as
well as community nursing field denoting the duration of such placement together with the placement
of theoretical teaching blocks/ periods.
9.6.2. Factors Related to Planning Clinical Rotation

❑❑ Objective of the course can be used as guideline for planning.
❑❑ Number of students in each class.
❑❑ Number of clinical areas as well as the size of the department.
❑❑ Presence of students of the other programmes on the same field.
❑❑ The agency’s authorities concerns and considerations.
❑❑ Duration of experience in each area.
❑❑ Number of persons available for supervision.
❑❑ Indian Nursing Council requirements.
9.6.3. Basic Principles in Planning Clinical Rotation

❑❑ Clinical rotation plan must be in accordance with the total curriculum plan. Theoretical instruction
should precede clinical experience.
❑❑ Clinical instructor to student ratio should be 1:4
❑❑ Selection of area from simple to complex
❑❑ B Sc or GNM 1st year student get maximum supervision
❑❑ Each student to be provided with experience in each block.
❑❑ No block should be missed.
❑❑ Overcrowding with different groups of students should be avoided.
❑❑ When outside agencies are selected for clinical experience, continuity of service must be
maintained.
❑❑ Rotation plan must be prepared in advance.
The commonly used methods of organizing clinical learning experiences through rotation plan are:
❑❑ Teaching block: These are full time teaching sessions during which students are engaged in theo-
retical instructions. Posting for full time clinical experience is made after the teaching block is
over. Usually there are 4-6 weeks teaching block before posting to clinical area, thereafter, stu-
dents may be withdrawn from clinical at regular intervals for second and third teaching block as
per plan.
❑❑ Partial block system: It includes no full time clinical as well as theory classes. Usually students
are posted in clinical area in the morning shift to lunch time, thereafter they have theory classes.
❑❑ Study day system: One or two days in a week are planned for full time classes and for rest of the
days there would be full time clinical.
Chapter 12.indd 261 5/18/2012 11:53:00 AM

10. E VALUATION OF THE CURRICULUM OR LEARNING

E XPERIENCES
Evaluation is a systematic process of determining the extent to which educational objectives laid down
in a curriculum have been achieved.
Purpose of Evaluation
❑❑ To find out to what extent objectives of the programme have been attained.
❑❑ For certification purpose.
❑❑ To provide guidelines for decisions about a curriculum, revision modification and shift of em-
phasis.
❑❑ Designed to protect the society to prevent incompetent personnel from practicing nursing.
10.1. Types of Assessments

❑❑ Formative Assessment: It is an ongoing evaluation to measure the progress made by the students.
The purpose is to provide feedback to students & teachers at regular intervals. Its results may form
a part of the internal assessment.
❑❑ Summative Assessment: It is the final Evaluation of the student done at the end of the course. Part
of the summative assessment may be based on formative assessment.
11. CURRICULUM DEVELOPMENT MODELS

In the past, curriculum development in nursing has been influenced by various classical curriculum de-
velopment models that reflect different curriculum development paradigms. These models contributed
towards progress in nursing education.
11.1. Linear, Prescriptive Model/Product Model/ Behavioral Objective

Model (Tyler 1945, Bloom 1965)
Linear, prescriptive curriculum development models are considered as normative models as they pro-
vide a sequence of steps that should be followed in any curriculum development initiative.
In this era of technology explosion curriculum is described as a product and education is most often
seen as a technical exercise which includes setting objectives, drawing up a plan, implementing the plan
and measuring the outcomes or products. It is a way of thinking about education that has grown in influ-
ence since the late 1970s with the rise of vocationalism and the concern with competencies.
The concept of curriculum as a product was influenced by the development of management think-
ing and practice. The theory of ‘Scientific Management’ proposed by F W Taylor advocated division
of labor to simplify job tasks, extension of managerial control over all elements of the workplace and
cost accounting based on systematic time-and-motion study. All these three elements are involved in
the product model of the curriculum. One of the important features of this model is that it pays atten-
tion in detail to what people need to know in order to work, live their lives and so on. Tasks or jobs are
analyzed and broken down into their component elements and then lists of competencies are drawn up
to be included in curriculum. Therefore, the curriculum as a product cannot be the result of ‘armchair
speculation’ but it is the product of a systematic study of the jobs. The Progressive movement lost much
of its momentum in the late 1940s in the United States and from that period the work of Ralph W. Tyler
has made a lasting impression on curriculum theory and practice.
Chapter 12.indd 262 5/18/2012 11:53:00 AM

Tyler maintained that the real purpose of education is not to have the instructor perform certain ac-
tivities but to bring about significant changes in the students’ pattern of behavior. Therefore, it becomes
important to recognize that any statement of objectives of the school should be a statement of changes
to take place in the students. (Tyler 1949)
Tyler’s curriculum development model is an example of linear, prescriptive curriculum development
models. This model represents technical, objectives driven approach whereby educators specify the
desired product of an educational programme and use this as a point for curriculum development (Lovat
& Smith, 1995). The development of the product model of the curriculum is based on the answers of
the following questions:
❑❑ What are the aims and objectives of a curriculum?
❑❑ Which of the learning experiences meet these aims and objectives?
❑❑ How can the extent to which these aims and objectives have been met and evaluated?
❑❑ How can these learning experiences be organised? (Adapted from Tyler 1949)
Advantages of Product Model

❑❑ Avoidance of vague general statements of intent
❑❑ Makes assessment more precise
❑❑ Helps to select and structure content
❑❑ Makes teachers aware of different types and levels of learning be involved in some particular
subjects
❑❑ Guidance for teachers and learners about skills to be mastered
Criticism of Product Model

❑❑ At lower levels, behavioural objectives may be trite and unnecessary
❑❑ It is difficult to write satisfactory behavioural objectives for higher levels of learning
❑❑ Specific behaviours may not be appropriate for the affective domain
❑❑ It discourages creativity for learner and teacher
❑❑ It enshrines psychology and philosophy of behaviourism
❑❑ Curriculum becomes too subject and exam bound
❑❑ Plan or programme assumes greater importance as compared to learner. Students are told what
they must learn and how they should do it.
❑❑ Educators are judged only by the products of their actions; therefore, it turns educators into technicians.
❑❑ It entails that behavior can be objectively and mechanistically measured. In order to measure,
things have to be broken down into smaller and smaller units. This can lead to shift of focus on
the parts rather than the whole.
❑❑ It can lead to an approach of education and assessment which resembles a shopping list. When all the
items in the list are ticked off, the person has passed the course or has either learnt something or not.
❑❑ It is a model of curriculum theory and practice largely imported from technological and industrial
settings. The difficulties that educators experience with objectives in the classroom may point to
something inherently wrong with the approach, that it is not grounded in the study of educational
exchanges.
❑❑ Educators and learners can overlook learning that is occurs as a result of their interactions, but that
which is not listed as an objective.
Chapter 12.indd 263 5/18/2012 11:53:01 AM

Simplicity and rationality of product model has been powerful factors in its success. A further appeal
has been the ability of academicians to use the product model to attack teachers to use the objectives
model as a stick with which to beat teachers. ‘What are your objectives?’ is more often asked in a tone
of challenge than one of interested and cooperative inquiry. (Stenhouse 1974)
11.2. Process Model of Curriculum (Key Thinker Stenhouse (1975))

The proponents of process model of curriculum argued that curriculum is not a physical thing; rather, it
is the interaction of teachers, students and knowledge. In other words, curriculum is what actually hap-
pens in the classroom and what people do to prepare and evaluate.
Lawrence Stenhouse (1975) explored process model of curriculum. He defined curriculum as “an attempt
to communicate the essential principles and features of an educational proposal in such a form that it is open
to critical scrutiny and capable of effective translation into practice”. He suggested that a curriculum is rather
like a recipe in cookery, a recipe can vary according to taste, so can a curriculum. (Stenhouse 1975: 4-5)
Stenhouse strongly argued that curriculum is not a package of materials or a syllabus of ground to
be covered rather it is a way of translating any educational idea into a hypothesis testable in practice. It
invites critical testing rather than acceptance.
The learners in this model are not objects to be acted upon. They have a clear voice in the way that
the sessions evolve. Therefore, attention shifts from teaching to learning whereas, the product model
by having a pre-specified plan or programme tends to direct attention to teaching rather than learning.
Curriculum should provide a basis for planning a course, studying it empirically and considering the
grounds of its justification. It should offer: (Stenhouse 1975)
❑❑ Principle for the selection of content - what is to be learned and taught
❑❑ Principles for the development of a teaching strategy - how it is to be learned and taught.
❑❑ Principles for the making of decisions about sequence.
❑❑ Principles on which to diagnose the strengths and weaknesses of individual students and differen-
tiate the general principles listed above to meet individual cases.
❑❑ Principles on which to study and evaluate the progress of students.
❑❑ Guidance as to the feasibility of implementing the curriculum in varying school contexts, pupil
contexts, environments and peer-group situations.
❑❑ A formulation of the intention or aim of the curriculum which is accessible to critical scrutiny.
Process Model Focuses on
❑❑ Student and learner activities (perhaps most important feature)
❑❑ Conditions in which learning takes place
❑❑ Emphasis on means rather than ends
❑❑ Learner should have part in deciding nature of learning activities
❑❑ More individualised atmosphere
❑❑ Assumption that learner makes unique response to learning experiences
Advantages
❑❑ Emphasis on active roles of teachers and learners
❑❑ Emphasis on learning skills
❑❑ Emphasis on certain activities as important in themselves and for “life”
Chapter 12.indd 264 5/18/2012 11:53:01 AM

Problems of Process Model of Curriculum

❑❑ Neglect of considerations of appropriate content
❑❑ Difficulty in applying approach in some areas
❑❑ The process model of curriculum places meaning-making and thinking at its core and treats learn-
ers as subjects rather than objects, therefore, it can lead to very different means being employed
in classrooms and a high degree of variety in content.
❑❑ It may not pay enough attention to the context in which learning takes place.
❑❑ The major weakness (or strength) of the process model is that it rests upon the quality of teachers.
The approach is dependent upon the cultivation of wisdom and meaning-making in the classroom
which requires quality of teachers.
11.3. Competency Based Curriculum Model

The focus in competency based curriculum is on the competency in tasks that a nursing student needs to
do later as a competent professional. A competency based model for nursing education was developed
by Ken Cox in the year 1991.
Concept of Competency
The concept of professional competence is defined by International Labor Organization as the ap-
titude to carry out a task or job position effectively, on account of possessing the qualifications
required for such. In this case, the concepts of competence and qualification are tightly associated,
seeing as how qualifications are considered the acquired capability to fulfill duties or carry out a
job position.
Competency is the ability of a nursing student enabling him to successfully carry out professional
activities, at the same time it is not a probability of success in the execution of one’s job; it is a
real and demonstrated capability. It consists of components that are trainable (knowledge, skills and
attitude).
Competency therefore, refers to an integrated set of skills, knowledge, and attitudes that enables
one to effectively perform the activities of a given occupation or function to standards expected in
employment.
Competencies are aspects of the person as a whole, comprising:
❑❑ Aptitude (verbal, numerical)
❑❑ Skills and abilities (managerial, communication, leadership)
❑❑ Knowledge (general, professional, and job specific)
❑❑ Personality (social orientation)
Important Characteristics of Competency Based Curriculum

❑❑ Competencies are carefully identified, verified and of public knowledge
❑❑ Instructions are aimed at the development of each competency. Instructions are as individualized
as possible.
❑❑ The evaluation focuses on knowledge, attitude and performance as the main source of evidence.
❑❑ The progress of the students within the programme goes as per the rhythm of each person.
❑❑ The learning experiences are guided by permanent feedback
Chapter 12.indd 265 5/18/2012 11:53:01 AM

Dimension of CBC Curriculum Development

❑❑ Identification of competencies
❑❑ Standardization of competencies
❑❑ Competency based training
❑❑ Certification of competence
Universities, boards and other organizations in the technical and vocational or professional education
in the world find competency based curriculum development a way of preparing graduates to function
in a fast changing context.
Steps of Developing Competency Based Curriculum
❑❑ Define competencies : Definition of professional requirements in terms of KAP (competencies).
At the begining of the course students are informed about competencies to be demonstrated at
the end.
❑❑ Formulate learning objectives : Determination of professional requirements and learning
objectives.
❑❑ Plan learning experiences : Translation of learning objectives and attainment targets into learning
plan describing topics to be taught, teaching approaches and assessment targets.
❑❑ Planning and implementing the teaching-learning strategies in competency based curriculum.
❑❑ Planning and implementing the evaluation strategies for competency based curriculum.
Stepwise Investigations of Competencies

❑❑ Consider the level (graduate, starting position or postgraduate higher position)
❑❑ Consider the role (task, process, people oriented)
❑❑ Consider the other relevant contextual variables (production, organizational, societal dimension)
❑❑ Identify relevant competency categories and competency cluster (interpersonal, task oriented,
intrapersonal)
❑❑ Create behavioral indicators (concrete behavioral terms that makes the competencies Observable
and measurable)
❑❑ Establish the relative importance and level of mastery of each competency (frequency of use, dif-
ficulty or criticality and consequences of error etc)
Teaching-Learning Strategies in CBC
❑❑ Teachers provide the learners an opportunity to interact with real life situation and use their per-
sonal resources (general knowledge, procedural knowledge, cognitive skills and relational knowl-
edge) in combination to acquire a competency.
❑❑ Teachers need to select the teaching methods and situations that lead to activities that facilitate the
acquisition of competencies given the learners prior knowledge.
❑❑ In order for a learner to be able to act competently, requires the learner to be able to combine and
mobilize a series of personal resources that involve:
❑❑ General, conceptual and disciplinary knowledge.

❑❑ Operative, procedural knowledge. For example: operating a machine such as ECG machine
or carrying out the nursing procedure.
Chapter 12.indd 266 5/18/2012 11:53:01 AM

• Competence which involes the application of knowledge in the performance of a

range of varied work activities, most of which may be rotine and perdictable.
Level 1
• Competence which involes the application of knowledge in a significant range of

work activities, performed in a variety of contexts. Some of these activities are
Level 2 complex or rotuine and there is some individual responsibility.
• There is cosiderable responsbility as well as autonomy and control or guidance

of others is often required.
Level 3
• Sustained degree of personal responsibility and autonomy. Responsibilty for the

work of ohters and the allocation of reaources is often present.
Level 4
• Very substantial personal autonomy, significant responsiblity for the other’s work
and for the allocation of substantial resources is involed. There are peersonal
Level 5 accountablities for analysis, diagnosis, design execution, and evaluation.
Figure 12.5 Levels of Competency
❑❑ Knowledge to carry on intellectual operations: For example: reasoning, inductive

generalization, analysis of statistical data and synthesis.
❑❑ Knowledge for social relations: For example: Working in group, communicating effectively.
It is important for the teacher:

❑❑ to pay attention to what personal resources learners have;
❑❑ to have information in relation to previous knowledge learners already possess;
❑❑ to identify which strategies, methods and learning techniques to be prioritised in order to facilitate
resource combination to acquire the competencies.
Evaluation Strategies in CBC

It is the process by which teachers and learners check the learning. Results indicates what has been
learned and to what extent the competencies have been achieved for the set standard. While evaluating
competencies, it is important to determine which evaluation criteria will be designed to evaluate com-
petency acquisition. Students are expected to demonstrate the required outcomes and they are assessed
whether they can demonstrate those outcomes. It is recommended to evaluate student learning outcomes
within a competency-based outcomes curriculum at 3 levels:
❑❑ Evaluate knowledge or ability (results in tests)
❑❑ Evaluate results for tasks performed (degree of completion of tasks or activities)
❑❑ Evaluate know-how-to-be (degree of contribution in work tasks, their attitude, values, etc).
Chapter 12.indd 267 5/18/2012 11:53:01 AM

Progress in the Passes

Student passes the course programme
Traditional
nursing Reassess the
educational
programmes student
Repeat the
Student fails programme or
exit the course Fails
Figure 12.6 Traditional Educational Programme
Progress in the
Student demonstrate the competency programme
Competency Demonstrate competency

based nursing
education
programme
Reassessment
Remediation,
learner responsible,
Student does’nt demonstrate the competency accountable for
own learing Does’nt demo. competency
faculty in supportive
role
Figure 12.7 Competency Based Educational Programme
It is important to use combination of assessment techniques to cover all three levels of evaluation:
❑❑ Self assessment
❑❑ Participation in class/group activities
❑❑ Observations while performing particularr procedure.
❑❑ Assignments (individuals/group)
❑❑ Keeping Journals
❑❑ Investigations/surveys (individual or group)
Chapter 12.indd 268 5/18/2012 11:53:02 AM

❑❑ Tests
❑❑ Exams etc.
Student Competency Record (SCR)

It is an invaluable tool toward real articulation and accurate record keeping of student progression and
success in competencies and courses. It is required if the program is using competency-based scheduling.
11.4. Objective Based Curriculum

Objective based curriculum is a method of curriculum design and teaching that focuses on what students
can actually do after they are taught. It takes in to consideration the final outcomes of an education pro-
gram on priority basis as compared to learning objectives in the traditional educational system.
The traditional educational model in nursing focus on the learning objectives first which are taught by the
teachers in the hope that at the end of the course or training student nurses will convert into professionally
competent nurses having adequate knowledge of diseases, diagnostic tests, interpersonal skills, communica-
tion skills, basic nursing procedures, advance nursing procedure, managerial skills and so on. Whereas, ob-
jective based education takes into consideration as a first step of education process these final outcomes of a
traditional educational system so that it can be ensured that the final product (professional or registered nurse)
will definitely have these desired expectations that may not be possible with traditional education model.
Questions addressed by objective based curriculum:
❑❑ What do you want the students to learn?
❑❑ Why do you want them to learn it?
❑❑ How can you best help students learn it?
❑❑ How will you know what they have learnt?
Need of Objective Based Curriculum
❑❑ Objective based education is sufficiently equipped to assess ‘what the students are capable of
doing’ which the traditional education system of nursing often fails to do.
❑❑ Since nursing is a profession which plays with life and death issues, they require highly competent
professional nurses.
❑❑ If the education system of nursing is not sound enough to evaluate ‘what the students are capable
of doing’ it is unfair to the society.
❑❑ It requires the students to understand the contents by “extending the meaning of competence
far beyond that of narrow skills and the ability to execute structured tasks in a particular subject
area.” (Spady, 1995).
❑❑ Objective based education put demand on the student that he or she has to demonstrate nursing
skills through more challenging tasks like writing project proposals and completing the projects,
case presentations in clinical areas and analysing case studies etc. Such challenging tasks require
nursing students to think critically, make decisions and give presentations.
Characteristics of Objective Based Curriculum

❑❑ There is a clear focus on learning outcomes.
❑❑ It recognises that all students can succeed.
❑❑ It provides with opportunities to students for self-assessment
Chapter 12.indd 269 5/18/2012 11:53:02 AM

❑❑ It values the different backgrounds, interests, prior experiences and learning styles of students.
❑❑ Students are provided with opportunities to progress and demonstrate learning outcomes in more
than one context.
❑❑ There is sufficient flexibility in the curriculum to cater different characteristics and learning needs
of students.
❑❑ Planning of experiences which promote learning as well as assessment occurs at the same time.
Principles of Objective Based Education

❑❑ Clarity of focus about outcomes: The focus of objective based education is on outcomes which
influences the all steps of educational process.
❑❑ Backward approach to designing curriculum: Curriculum is designed by backward approach as
compared to traditional educational model by selecting outcomes first, than deciding on teaching
material and methods, assessment strategies etc.
❑❑ Consistent, high expectations of success: Expect students to succeed by providing them encour-
agement to engage deeply with the issues they are learning and to achieve highly challenging
standard (Spady, 1995).
❑❑ Expanded opportunity: There is scope for every learner to learn at his/her own pace.
Determine the final outcome

of a nursing educational
programme
(ANM/GNM/Bsc/Msc)
Plan the learing experiences

to achieve these
outcomes/goals/objectives
Arrange these learing

experienes in priority order
Select teaching learning

materials and methods to Determine tools and
achieve set objectives techniques of evaluation
Figure 12.8 Steps in Development of Objective Based Education
Chapter 12.indd 270 5/18/2012 11:53:02 AM

Objective based education satisfies individual student needs and differences through the expansion of
available time and resources so that; all students can succeed to reach the exit outcomes.
Process of Objective Based Curriculum
❑❑ The process in objective based curriculum is reverse of that associated with traditional educa-
tional process.
❑❑ The desired outcome is selected first and the curriculum, teaching materials and assessments or
evaluation are planned to obtain the intended outcome (Spady 1988).
❑❑ All curriculum and teaching decisions are made based on how best to facilitate the desired final
outcome.
Towers (1996) listed four points to the OBE system that are necessary to make it work:
❑❑ What the student is to learn must be clearly identified.
❑❑ The student’s progress is based on demonstrated achievement.
❑❑ Multiple instructional and assessment strategies need to be available to meet the needs of each student.
❑❑ Adequate time and assistance need to be provided so that each student can reach the maximum
potential.
12. CURRICULUM DEVELOPMENT AND ACTION RESEARCH

Action research is a stepwise approach which includes problem identification, action planning, imple-
mentation, evaluation, and reflection. The insights gained from the initial cycle are fed into planning of
the second cycle, for which the action plan is modified and the research process is repeated.
Action research methodology offers a systematic approach to introduce innovations in teaching and
learning. It seeks to do this by putting the teacher in the dual role of producer of educational theory as
well as the user of that theory. This is both a way of producing knowledge about higher education learn-
ing and teaching as well as a powerful way of improving learning and teaching practice. No separation
need be made between the design and delivery of teaching, and the process of researching these activi-
ties, thereby bringing theory and practice closer together.
Through systematic, controlled action research, higher education teachers can become more profes-
sional, more interested in pedagogical aspects of higher education and more motivated to integrate
their research and teaching interests in a holistic way. This leads to better academic programmes and
improvement of student learning. (Zuber Skerritt, 1982)
Nursing education is in a transition phase and there is a shift to competency based education and ob-
jective based education because the traditional curriculum has been unsuccessful to produce the nurses
who are competent enough to provide quality patient care. Competency based or objective based educa-
tion can be useful in this era of quality assurance.
Chapter 12.indd 271 5/18/2012 11:53:02 AM

CHAPTER HIGHLIGHTS
❑❑ Curriculum is referred as the totality of the learning experiences a student gets during an educa-
tional program.
❑❑ The term curriculum is derived from a Latin word “currere” which means to run; a course; race-
chariot.
❑❑ The types of curriculum are: core curriculum, open curriculum, explicit (expressed) or overt or
written or official curriculum, implicit (or hidden) or covert curriculum, null curriculum, societal
curriculum, institutional curriculum, instructional curriculum and integrated curriculum.
❑❑ Curriculum development is based on some social, psychological and scientific principles which
are important consideration while developing curriculum.
❑❑ Curriculum is both a process and product
❑❑ Curriculum as a process is not a physical thing; rather, it is the interaction of teachers, students and
knowledge. Lawrence Stenhouse (1975) explored process model of curriculum.
❑❑ Curriculum development is the process of planning, implementing and evaluating learning op-
portunities intended to produce desired changes in learners.
❑❑ Philosophy is the wisdom and education transmits this wisdom.
❑❑ Philosophical assumptions direct the development of educational objectives.
❑❑ The act, content, condition and criteria are the key components of educational objectives.
❑❑ In traditional approach of curriculum development content is derived first and then objectives are
determined while, in objectives based education, educational objectives are determined first and
on the basis of laid down objectives course content is developed.
❑❑ In outcome based education there is a move from the “How” and “When” to the “What” and
“Whether” of education. An outcome is something that follows as a result of consequence. In this
approach of curriculum development terminal objectives are re-titled as outcomes
❑❑ Learning experiences refers to deliberately planned experiences in selected situations where stu-
dents actively participate, interact and which result in desirable change of behavior of students
(learning).
❑❑ Learning experiences should be sufficiently varied to prevent boredom, allow for and exploit
the potential for individual student differences. It should also enable participation in some trans-
cultural experiences.
❑❑ Learning experiences are systematically arranged to increase the cumulative impact of many in-
dividual learning experiences.
❑❑ There are two types of integration of learning experiences: vertical integration and horizontal
integration.
❑❑ Master rotation plan is an overall plan of rotation of all the students in a particular education insti-
tution showing the placement of students belonging to various groups/ classes in clinical nursing
as well as community nursing field denoting the duration of such placement together with the
placement of theoretical teaching blocks/ periods.
❑❑ Linear, prescriptive model/product model/ behavioral objective model (Tyler, 1945 Bloom 1965)
provide a sequence of steps that should be used in any curriculum development initiative.
❑❑ Process model (Stenhouse, 1975) focuses on teacher activities and teacher’s role, student and learner
activities, conditions in which learning takes place, and emphasises on means rather than ends.
Chapter 12.indd 272 5/18/2012 11:53:02 AM

❑❑ A competency based model for nursing education was developed by Ken Cox in the year 1991.
It seeks to develop in learners the ability to know, to do and to be in order to deal with new and
changing circumstances.
❑❑ Dimension of competency based model curriculum development includes identification of com-
petencies, standardization of competencies, competency based training and certification of com-
petence
❑❑ Objective based curriculum is a method of curriculum design and teaching that focuses on what
students can actually do after they are taught. It takes in to consideration the final outcomes of an
education program on priority basis as compared to learning objectives in traditional educational
system.
EVALUATE YOURSELF
Q 1: Write a short note on clinical rotation plan in B Sc nursing III year? (RGUHS 2007)
Q 2: Define curriculum? Explain the steps and various levels of curriculum with example? (NIMS,
2010 RGUHS 2010)
Q 3: Explain the factors influencing curriculum development in nursing? (NIMS 2009)
Q 4: Explain the selection and organization of learning experiences? (NTRUHS 2009)
Q 5: Enumerate the principles of curriculum development (RGUHS 2009)
Q 6: What are the factors which influence development of clinical rotation plan (RGUHS 2010)
Q 7: Explain any one type of curriculum (MGR 2007)
Q 8: Explain the factors to be considered when selecting and organizing learning experiences for
students (RGUHS 2008)
Q 9: Write a short note on Master rotation plan and its importance in basic B Sc nursing programme?
(RGUHS 2008)
Q 10: Critically evaluate the B Sc nursing curriculum prescribed by INC (NIMS 2009)
Q 11: Write short notes on:
❑❑ Competency based curriculum model
❑❑ Objective based curriculum model
❑❑ Evaluation of curriculum
❑❑ Steps in curriculum development
REFERENCES/ FURTHER READINGS

1. Kelly, A. V. (1983; 1999) The Curriculum. Theory and practice 4e, London: Paul Chapman.
2. Tyler, R. W. (1949) Basic Principles of Curriculum and Instruction, Chicago: University of Chicago
Press.
3. Stenhouse, L. (1975) An introduction to Curriculum Research and Development, London:
Heineman.
4. Eisner, E.W. (1994) The educational imagination: On design and evaluation of school programs.
(3rd. ed) New York: Macmillan.
Chapter 12.indd 273 5/18/2012 11:53:02 AM

5. Longstreet, W.S. and Shane, H.G. (1993) Curriculum for a new millennium. Boston: Allyn and
Bacon.
6. Oliva, P. (1997) The curriculum: Theoretical dimensions. New York: Longman.
7. Young, M. & Leney, T. (1997) From A-levels to an Advanced Level Curriculum of the Future in
Hodgson, A. & Spours, K. (eds) (1997) Dearing and Beyond. London: Kogan Page
8. Marsh, C.J. (1997) Perspectives: Key concepts for understanding curriculum 1. London: Falmer
Press
9. Bates I, Bloomer M, Hodkinson P & Yeomans D (1998) “Progressivism and the GNVQ: context
ideology and practice” Journal of Education and Work, 11, 22, 109-25)
10. Pinar, W.F., Reynolds, W.M., Slattery, P., & Taubman, P.M. (1995). Understanding curriculum.
New York: Peter Lang.
11. Bellack, A.A., & Kliebard, H.M. (1977). Curriculum and evaluation. Berkeley: McCutchan.
12. Hass, G. (Ed.) (1987). Curriculum planning: A new approach. Fifth edition. Boston: Allyn and
Bacon.
Chapter 12.indd 274 5/18/2012 11:53:02 AM

c h a p t e r 13
Information, Education, and
Communication for Health
1. INTRODUCTION
Community health nurse or public health nurse is engaged in the delivery of health services to the public
or community. Health education constitutes major thrust area of community nursing services. The focus
of health education is on health risk, risk factors to health problems, and behavioral modification of the
individual or group to achieve the desired health goals. Since an individual’s own actions or behavior
can make him/her healthy or ill, modification of health behavior is the ultimate aim of health education.
In the next section, we discuss about health behavior and the various factors affecting it.
2. DEFINING HEALTH BEHAVIOR

❑❑ Health behavior refers to the actions taken by an individual to attain, maintain, and regain good
health and to prevent illness. It is shaped by and reflects the health beliefs of a person.
❑❑ Health behavior is any activity undertaken by an individual, regardless of the actual or perceived
health status, for the purpose of promoting, protecting, or maintaining health.
Certain people behave in a healthy way while others do not. Given below is the list of factors that affect
the health behavior of a person.
❑❑ Thoughts and feelings
❑❑ Knowledge
❑❑ Beliefs
❑❑ Attitudes
❑❑ Values
❑❑ Culture
A person has many different thoughts, feelings, and ideas in his/her mind about the world. Furthermore,
these thoughts or feelings are shaped by knowledge, beliefs, and attitudes of a person. Belief is some-
thing which is accepted on the basis of faith not on objective evidences. The factors that affect the belief
of a person include the influence of parents, relatives, friends, and significant others. It affects the health
status of a person as it can be beneficial, injurious, or neutral. For example, if parents have the habit
Chapter 13.indd 275 5/18/2012 11:53:18 AM

of smoking, then it can lead to a positive belief in the mind of child that smoking is something which
is not injurious, and this may encourage the child to start smoking. Similarly, peers and other relatives
also affect the development of belief of a person as they have major influence on the thinking of person
through communicating knowledge, values, and other information.
Values constitute another factor that affects the health behavior of a person. It refers to thoughts and
feelings to which one attaches the most worth and importance.
The culture to which a person belongs also has an impact on the health behavior of a person. Each
culture has its own way of doing things and has its own system of beliefs. For example, in some culture
there is belief that mother’s first milk (colostrums) should be discarded as it is for the God and is not
beneficial for the child. This cultural tradition has been transferred from generation to generation and
has integrated with the health behavior of that cultural community.
Self-efficacy is an important concept that operates in the process of behavior change. Self-efficacy
refers to a person’s impression of his/her own ability to perform a task that is challenging or demanding
in nature. It is determined by some variables such as his/her prior success in the similar type of tasks,
physiological state, and outside sources of persuasion. It is a good predictor of the amount of effort
an individual will put in initiating and maintaining a behavioral change. Self-efficacy has become an
important element of many of the theories, for example, health belief model (HBM) and the theory of
planned behavior.
Health education in terms of “health behavior modification” aims to encourage positive behaviors
and to discourage negative health behavior among people.
Modification in health behavior is not as easy as it seems theoretically. It is the most difficult and
cumbersome task because the human behavior is deeply rooted in the thinking, attitude, values, and
health beliefs of a person. A nurse can use different strategies to help a person or community to modify
their health behavior and adopt a behavior that is good for health.
❑❑ Forceful/punishment: A democratic government can control the health behavior of the citizens by
enacting law, rules, and regulations. For example, the government of India has banned smoking at
public places and helmet and seat belts are necessary for all the drivers.
❑❑ Informed choices: Nurses’ help people to make informed choices by providing them all the
necessary information relating to their health.
There are a number of behavioral change theories and models that attempt to explain the reasons
behind alterations in individual’s behavioral patterns. These theories allude to environmental, person-
al, and behavioral characteristics as the important factors in behavioral determination. Some of the
important theories of behavior change are given below:
❑❑ Health Belief Model
❑❑ Social cognitive theory (Albert Bandura)
❑❑ Theory of reasoned action and planned behavior
❑❑ Transtheoretical model (James Prochaska and Carlo DiClemente)
2.1. Health Belief Model

The HBM was developed in the 1950s by the United States Public Health Service to explain the lack
of public participation in health screening and prevention programs. The model focuses on the attitude
and beliefs of an individual to explain and predict their health behaviors. After the development of the
model, it has been applied to explore sexual risk behaviors, transmission of HIV and in other short-and
Chapter 13.indd 276 5/18/2012 11:53:18 AM

Information, Education, and Communication for Health | 277
long-term health behavior. The key variables of the HBM are as follows (Rosenstock, Strecher, and
Becker, 1994):
❑❑ Perceived Threat: It is further divided into two parts: perceived susceptibility and perceived severity
of a health condition.
Perceived susceptibility: It is the subjective perception of the risk of contracting a health condition.
Perceived severity: It refers to feelings that are concerned with the seriousness of getting a disease
or of leaving it untreated which includes evaluations of medical, clinical, and social consequences.
❑❑ Perceived Benefits: It refers to the perceived benefit of the strategies designed to reduce the threat
of disease or illness.
❑❑ Perceived Barriers: These are the consequences that may happen due to the particular health ac-
tions, including physical, psychological, and financial demands.
❑❑ Cues to Action: Cues to action are those events or happenings which may be either bodily (physi-
cal signs and symptoms of a disease) or environmental (public awareness camp) that motivate an
individual to take action.
❑❑ Self-Efficacy: This concept was introduced by Bandura in 1977. As described in the previous sec-
tion, it refers to the ability of a person to successfully execute the behavior required to produce
the desired outcomes (Figure 13.1).
Sociodemographic variables:
Background age, sex, occupation,
factors education etc.
Perceived expectations
Perceived threats
• Perceived benefits to action
Perceptions • Perceived susceptibility
• Perceived barriers to action
• Perceived severity of illness
• Self efficacy to perform action
Action cues
• Media Modified behaviour to reduse
• Reminder threats (based on benefits)
• Personal influence
Figure 13.1 Health Belief Model

Source: Rosenstock I., Strecher V., Becker M. (1994). The Health Belief Model and HIV risk behav-
ior change. In R.J. DiClemente and J.L. Peterson (Eds.), “Preventing AIDS: Theories and methods of
behavioural interventions”, New York: Plenum Press. pp. 5–24.
Chapter 13.indd 277 5/18/2012 11:53:18 AM

2.2. Social Learning/Social Cognitive Theory

Social learning theory was proposed by Albert Bandura. According to this theory, environmental,
personal, and behavioral elements affect behavior change. Each element reciprocally affects each other.
For example, a person’s environment affects the development of personal characteristics as well as the
person’s behavior, and an individual’s behavior may change their environment as well as the way the in-
dividual thinks or feels. Therefore, social learning theory focuses on the reciprocal interactions between
these factors, which are hypothesized to determine behavioral change.
2.3. Theory of Reasoned Action

This theory hypothesized that human beings are rational. It proposes that before performing the particular
type of behavior, an individual consider the consequences of that behavior. Therefore, the “intention”
of the person to behave in a particular way becomes an important factor in determining behavior and
behavioral change. According to Icek Ajzen, intentions to behave in a particular way in a given situation
develop from a person’s perception of that behavior as positive or negative as well as the social impres-
sion of the behavior. Therefore, personal and social perception of a particular behavior determines the
intention to perform a behavior as well as behavioral change.
2.4. Theory of Planned Behavior

In 1985, Ajzen expanded upon the theory of reasoned action by proposing the theory of planned behavior.
It proposes that the behavior performance is proportional to the amount of control an individual pos-
sesses over the behavior as well as the to the strength of the individual’s intention in performing that
behavior. Self-efficacy is another important factor in determining the strength of the individual’s inten-
tion to perform a particular behavior.
2.5. Transtheoretical/Stages of Change Model

Change in behavior is not an abrupt process; rather, it occurs in stages over the period of time. Psychologists
developed the stages of change theory in 1982 to compare smokers in therapy and self-changers along a be-
havior change continuum. The purpose of staging patients was to tailor therapy to a person’s needs at his/her
particular point in the change process. According to the transtheoretical or stages of change model, behav-
ioral change is a five-step process which are given below (Prochaska, DiClemente, and Norcross, 1992):
❑❑ Precontemplation
❑❑ Contemplation
❑❑ Preparation
❑❑ Action
❑❑ Maintenance
Precontemplation: In this step, an individual has the health problem whether he recognizes it or not
and has no intention of changing.
Contemplation: Individual recognizes the problem and seriously thinks to change the behavior
leading to the problem.
Preparation: Individual intends to change the behavior within the next month. Some behavior change
efforts may be reported such as infrequent cigarette smoking. However, the defined behavior change
criterion has not been reached in this step (e.g., consistent absenteeism from smoking).
Chapter 13.indd 278 5/18/2012 11:53:18 AM

Action: Individual has enacted consistent behavior change (consistent absenteeism from smoking)
for less than 6 months.
Maintenance: Individual maintains new behavior for 6 months or more.
A variety of behaviors, such as smoking cessation and weight control efforts, have been explored in
USA populations using this theory (Prochaska, 1994). More recently, the Centre for Disease Control
and Prevention (USA) is using this theory in counseling of the HIV/AIDS patients as per their stage
of change.
3. HEALTH EDUCATION
Health education is an educational program or process which is directed to improve, maintain, and
safeguard the health care of the community. It is the process by which individuals and groups of people
learn to behave in a manner that is conducive to the promotion, maintenance, or restoration of their
health. It is a social science that stems from the biological, environmental, psychological, physical, and
medical sciences to promote health and prevent disease, disability and premature death through educa-
tion-driven voluntary behavior change activities. The purpose of health education is to positively influ-
ence the health behavior of individuals and communities as well as the living and working conditions
that influence their health.
As per the definition of health education adopted by John M Last, “It is the process by which
individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance
or restoration of health.”
The Joint Committee on Health Education and Promotion Terminology, 2001, defined Health
Education as “any combination of planned learning experiences based on sound theories that provide
individuals, groups, and communities the opportunity to acquire information and the skills needed to
make quality health decisions.”
The World Health Organization defined Health Education as “comprising of consciously constructed
opportunities for learning involving some form of communication designed to improve health litera-
cy, including improving knowledge, and developing life skills which are conducive to individual and
community health.”
Health education is defined as “Any combination of learning experiences designed to facilitate vol-
untary adaptation of behavior conducive to health.” The word “voluntary” is significant for ethical
reasons. Health educators should not force people to do what they don’t want to do, that is, all efforts
should be done to help people make decisions and have their own choices.
Alma Ata declaration (1978) has revolutionized the concept of health education. Before Alma Ata
declaration, the emphasis of health education was mainly on communicating health information to
change the health behavior of the people. There is shift on focus from prevention of diseases to promo-
tion of healthy lifestyle, from modification of individual behavior to modification of social environ-
ment, and promotion of individual and community self-reliance. The definition of health education as
per Alma Ata declaration is “a process which is aimed at encouraging people to want to be healthy, to
know how to stay healthy, to do what they can individually and collectively to maintain health, and to
seek help when needed.”
Meaning of Health Communication
Communication is the process of exchange of information between two or more people. Health
communication and health education are the terms that are used interchangeably. By health communi-
cation, we mean outward and downward communication of health knowledge to the audience.
Chapter 13.indd 279 5/18/2012 11:53:18 AM

3.1. Purposes of Health Education

❑❑ To promote health and prevent diseases
❑❑ For early diagnosis, management, and referral
❑❑ To promote the use of the available health services in the community.
❑❑ To develop a sense of self-responsibility among community people for health and health behavior
❑❑ To promote good health practices among individual patients as well as in the community. For
example, sanitation, clean drinking water, etc.
❑❑ To promote use of preventive services. For example, immunization, mammography, antenatal and
child health clinics.
❑❑ To promote the correct use of medications and the pursuit of rehabilitation regimens
❑❑ To improve the health status of individuals, families, communities, states, and the nation.
❑❑ By focusing on prevention, health education reduces the costs of medical treatment.
3.2. Characteristics of Effective Health Education

While planning for health education, the following characteristics of effective health education should
be given due emphasis:
❑❑ Health education should be directed at those people who have influence in the community (e.g.,
Sarpanch, Panch, Patel, Mukhiya, etc.).
❑❑ It uses simple local language with local expressions to communicate the health messages.
❑❑ It avoids jargons, technical words that are not understandable by the lay persons.
❑❑ It is adaptable and uses existing channels of communication. For example, songs, drama, and
storytelling.
❑❑ It should be repeated and reinforced over time using different methods.
❑❑ It uses demonstrations, role play, and nukkad natak to show the benefits of health behavior
modification.
3.3. Contents of Health Education

The content of the health education is determined by the need of the individual or community. Given
below are some important areas of health education which a nurse encounters in daily practices of
clinical or community work.
❑❑ Biological changes
❑❑ Nutrition
❑❑ Personal hygiene
❑❑ Personal habits
❑❑ Safety rules
❑❑ Knowledge of common disease and preventive measures
❑❑ Proper use of health services
❑❑ Sex education
❑❑ Special education for groups
❑❑ Breast feeding
❑❑ Immunization
Chapter 13.indd 280 5/18/2012 11:53:18 AM

❑❑ Oral rehydration
❑❑ Principles of healthy lifestyle (e.g., sleep, exercise)
3.4. Planning of Health Education

Planning of health education is based on the need of an individual or group for health education.
Decision has to be made regarding what the desired change in health behavior should be, where the
health education should take place (ward, school, community), and how it should be done.
The following steps can be taken in planning of the health education session:
❑❑ Identify the need for health education by an individual or group
❑❑ Determine the purposes of the health education for an individual or a group
❑❑ Determine the content for the education
❑❑ Prepare AV aids to communicate effectively with the general public
❑❑ Identify the settings/locations where the education can be delivered effectively
❑❑ Conduct the health education session
❑❑ Evaluate the health education
3.4.1. Identifying the Need for Health Education

The first step in the planning of health education is to decide the key health problems of the individual
or group and the advices that should be given. Any proposal for a change of health behavior should be
simple to put into practice with the existing knowledge and skills. It should not conflict with local cul-
tural beliefs, and more importantly, it should meet a felt need of the individual or community. A good
health education programme should modify the routine advices to fit in with people’s circumstances.
For example, education about nutrition should be based on foods that are available locally, aids for the
disabled made from local materials, and latrines built with traditional methods. If the planned change
in health behavior is hard to promote, it may be wise to start with a simple change that does fit in and
meets an immediate need of the individual or community. Once immediate need has been met and the
individual perceives clear-cut benefits, it may help in achieving a more difficult objective.
3.4.2. Planning for Venues of Health Education

Every encounter between a nurse and the patient or community provides an opportunity for health
education. It can be delivered in outpatient department, clinics, wards, bedside, schools, antenatal clin-
ics, immunization clinics, and homes. A nurse must decide about where the group is more easily avail-
able and at what location the surrounding and waiting areas for displays and demonstration will be
helpful in communicating health messages. Quiet areas where talks and small group discussions can be
held are valuable. It is important to remember that the most powerful way to implement change is role
modeling (practicing the preventive measures that are recommended to the community).
3.4.3. Communicating Health Message

There are varieties of approaches to communicate the health message to the target group in health
education. A most useful strategy is demonstration which is proven to be helpful if “satisfied users”
(e.g., successful users of weight reduction exercises and family planning) are used to show the benefits
of modified health behavior in health education session. All items used in demonstrations must be cheap
and available locally; otherwise, people will not accept it and will consider it irrelevant to their situation.
Chapter 13.indd 281 5/18/2012 11:53:18 AM

Word-of-mouth or oral publicity is another valuable way to influence actions of the community. In many
rural societies of India, oral traditions are strong and people more easily accept the message conveyed
by means of puppets, drama, and storytelling (e.g., the traditional Caribbean calypso song has been used
to promote family planning and oral rehydration solutions in a Caribbean country).
The effectiveness of one-to-one communication or small group discussion may be increased with
the use of AV aids such as leaflets, charts, posters, flash cards, flip charts, and flannel graphs, etc.
Films, slides, and film strips may be useful but have the disadvantage i.e., projectors are expensive, and
people may become so excited by the novelty of AV aid that they will pay no attention to the content
of health education. Radio programmes and recorded cassette are another good way to put over simple
information related to large populations.
3.4.4. Individual and Group approach to Health Education

Individual Approach
This is the approach of health education which is directed to an individual patient or family member.
It is a specific type of health education which is tailored to the need of the particular patient or fam-
ily member. The important feature of individual health education is that it is especially designed and
planned for a particular patient. For example, health education on hypertension may have different con-
tent for Mr. Ramesh and Mr. Ganesh as per the need of the patient. There are a number of opportunities
in the clinical area where a nurse can deliver health education to an individual patient.
Group Approach to Health Education
Group health education is an important area of work of a community health nurse. It is the type of health
education which is delivered to a group of community who has similar health needs for health educa-
tion. It can also be planned in connection with particular national health programme or health services
or epidemics for a particular community area. A community health nurse has to identify these groups in
community and plan health education for them. For example, it can be planned for commercial sex work-
ers, antenatal mothers, school children, eligible couples, and so on. Group health education focuses on
special requirements of a particular group, for instance, topic on oral hygiene for school children, dietary
requirement for antenatal mothers, barriers methods of contraception for eligible couples, and so on.
3.4.5. Audio Visual Aids

Health education session is like any teaching learning session in classroom which indeed requires AV
aids to facilitate learning. Selection of audio visual aids should be based on the requirement of the par-
ticular health education session. A nurse or nursing student has to prepare appropriate AV aids suitable
to the need of the topic, size of the group, and availability of resources. Please refer Chapter 8 on AV
aids for different types of AV aids that can be used for health education.
3.5. Principles of Health Education

There are certain principles that should be kept in mind by every staff nurse or public health nurse while
delivering health education to the individual patient or the community.
3.5.1. Principle of Motivation

Health education should awaken the desire to know and learn among the community members by
motivating them through the use of either primary motive (e.g., inborn desires, hunger, and sex) or
Chapter 13.indd 282 5/18/2012 11:53:18 AM

secondary motives (such as praise, love, recognition, and competition). The health message may not be
conveyed successfully if people are not motivated to listen and learn it. The important thing that should
be communicated is “what to do” and not “what not to do.” “Fear of disease” as a motive should not be
used regularly or perpetually in delivering health education.
3.5.2. Principle of Interest

People usually do not listen to that information in which they are not interested. Hence, health education
should relate to the interests of the community people. The people are not interested in health slogans
such as “take care of your health.” Therefore, it must focus on the need of the community (felt need) so
that they will be interested to listen and learn the health information.
3.5.3. Principle of Participation

This principle is based on the psychological principle of active learning. Health education must ensure
the active participation of the community people that will lead to better learning.
3.5.4. Principle of Comprehension

The public health nurse must know the level of understanding of the group member for which the teach-
ing is directed. One barrier to communication is the use of jargons or technical words which are difficult
to be comprehended by the lay person.
3.5.5. Principle of Reinforcement

Repetition and reinforcement of the health information at intervals is extremely useful to make the
learning long lasting.
3.5.6. Principle of Learning by Doing

Learning is an active process. The Chinese proverb “If I hear, I forget, if I see, I remember, if I do, I
know” illustrates the importance of “doing” for effective and active learning.
3.5.7. Principle of Known to Unknown

It is a very well-known maxim of teaching which emphasizes that the nurse should proceed from known
to the unknown content of the health topic while delivering health education to a group. The existing
knowledge of an individual should be used as a base on which the building of new knowledge can be built.
3.5.8. Principle of Simple Language

Health education must be delivered in simple local language and should be free from jargons that may
not be understood by the public.
3.5.9. Principle of Role Model

Health educator should exhibit the behavior that is compatible with the intended health message.
4. MASS MEDIA/MASS APPROACH FOR HEALTH EDUCATION

Mass communication occurs when a small number of people send message to a large anonymous and
usually heterogeneous audience through the use of specialized communication media. It is a one-way
flow of information, not interactive, and is mediated by sophisticated technology.
Chapter 13.indd 283 5/18/2012 11:53:18 AM

Mass media can be used for various purposes including health education. Channels for mass
c ommunication include radio, television, print, internet, video, films, pamphlets, role play, and
telecommunication.
4.1. Developing Media Strategy for Health Education

❑❑ The audience varies in their needs and motives so it is necessary to develop multiple messages
to cater to the various needs of the audiences. For high-risk group, the message should persuade
them to go for the screening test. Similarly, youth should be educated about causes of a disease
and how the risk could be minimized.
❑❑ The local, social values, and customs should be kept in mind while designing message.
❑❑ A message that fails to attract the attention of the target audience goes waste.
❑❑ The picture selected for a message must be a complete story in itself.
❑❑ To invite attention by arousing curiosity, a headline should generally be made up of three or four words.
❑❑ Use of positive emotions like humor and joy can catch the audience’s eye and convince individuals
to watch something that they might otherwise avoid.
❑❑ Combined media should be used to strengthen and reinforce information propagated by one media.
4.2. Mass Media Campaign

4.2.1. Use High-Quality Messages, Sources, and Channels
In order to develop better message, the campaign planner should acquire knowledge about the problems
they are addressing, target audience, and relevant social issues. Messages should be pretested with a
sample of target audience before final production. The channel of communication should be such, which
can easily reach to target audiences.
4.2.2. Disseminate the Messages Well

There are five mediators of effective message dissemination: media gate keepers, political and social
supports, financial supports, and target audience characteristics.
4.2.3. Attract the Attention of Target Audience

Target audience must be exposed to it, attend to it, process, and remember it. The most profound and
complex events and issues can be communicated simply and concisely.
4.2.4. Cause Individual Change

A mass communication campaign can change the awareness, opinion, knowledge, values, attitudes,
behaviors, and health of target audience.
4.2.5. Cause Societal Change

The long-term maintenance of individual level effects and ultimate effectiveness of a campaign require
parallel changes in the society.
4.3. Important Mass Media

4.3.1. Television
It can reach to people regardless of sex, age, income, or educational level. It offers sight and sound and
makes dramatic life like representations of people and products. It is an excellent means of transmitting
Chapter 13.indd 284 5/18/2012 11:53:18 AM

persuasive messages and eliciting a high degree of recall. Television is used by media units of the
ministry of information and broadcasting to disseminate messages regarding family planning, immuni-
zation, promotion of healthy lifestyle, and prevention of various communicable diseases. Certain cable
networks also devote significant amounts of broadcast time to health.
Advantages of Television as Mass Media
❑❑ Good mass market coverage
❑❑ Low cost per exposure
❑❑ Combines sight sound and motion
4.3.2. Radio
Radio can also reach to mass and diverse audiences. The specialization of radio stations by listener’s
age, taste, and even gender permits more selectivity in reaching different audience segments. Placement
and production costs are lesser for radio than for TV. Thus, radio is sometimes considered to be more ef-
ficient then the television. Radio health messages campaigns have been effective especially when com-
bined with posters and other mass media in the developing nations. It has been and is still being used
to create information regarding family planning, communicable diseases, and mother and child health.
Advantages of Radio as Mass Media
❑❑ Good local acceptance
❑❑ High geography and demographic selectivity
❑❑ Low cost
❑❑ Different time of broadcasting
Disadvantages of Radio as Mass Media
❑❑ Audio only
❑❑ Fleeting exposure
❑❑ Low attention
❑❑ Easy to forget
❑❑ Shallow reception
❑❑ Limited range
❑❑ Fragmented audiences
4.3.3. Newspaper
It is another important mass media as it deals every day with dissemination of current information
pertaining to different aspects of human life such as social, economic, political, and cultural. In a demo-
cratic country like India, the newspaper acts as powerful weapon in exposing the irregularities, short-
comings, failures of government policy and also functions as an eye opener of the public to various
national issues. Health messages contained in newspapers can reach many people and diverse groups.
Unfortunately, the print media is currently underutilized as a communication channel for highlighting
health issues among urban population.
4.3.4. Other Print Media

Pamphlets, brochures, and posters constitute other print media used to disseminate health messages.
These devices are readily found in most public health agencies, offices of private practitioners, health
Chapter 13.indd 285 5/18/2012 11:53:18 AM

care institutions, and voluntary health organizations. Various organizations such as WHO, UNICEF,
VHAI, and Centre for Health Education are bringing about various publications aimed at various groups
such as general population, media population, medical professional, and policy makers. The useful-
ness of print media has been found to be limited. According to estimates, only 7.1% of the Indian rural
population are exposed to any form of print media.
Strengths of Print Media
❑❑ Flexibility
❑❑ Mass reach
❑❑ Repetitive effect
❑❑ Reader’s convenience
❑❑ Economy
❑❑ Broad acceptability; high believability
Weakness of Print Media
❑❑ Short life of message
❑❑ Poor reproduction quality
❑❑ Language barrier
❑❑ Out of reach for illiterate
4.3.5. Outdoor Media

It includes posters, small hoardings, wall writing, billboards and signs, and electric sign boards. The
posters and small hoardings can be installed at railway stations, in buses, and at subways. For per-
sons who regularly pass by billboards or use public transportation, these media may provide repeated
exposure to messages.
Advantages of Outdoor Media
❑❑ 24-hour exposure
❑❑ Mass audience, medium high penetration, and public coverage
❑❑ Cost-effective
❑❑ Simple to understand
❑❑ Flexible
❑❑ High daytime visibility
Disadvantages of Outdoor Media
❑❑ Can allow limited message
❑❑ Loses visibility in the evening
❑❑ High blowing wind causes damages to boards
❑❑ Obliterates natural beauty of environment
4.3.6. Folk Media

About 90% of the world’s population live in developing countries and 70% of them live in rural areas.
Mass media such as newspapers, television, and the internet do not effectively reach to these people.
The higher rate of illiteracy added to the inadequate reach of mass media impedes almost 80% of the
Chapter 13.indd 286 5/18/2012 11:53:18 AM

I ndia’s population who reside in the rural areas. Therefore, the responsibility of mass communication
lies on folk media that have greater penetration to rural public. For example, puppetry as a folk me-
dia has contributed in raising awareness toward condom use and HIV/AIDS in India. Similarly, Alha,
the popular ballad of UP, and its counterparts like Laavani of Maharashtra, Gee-gee of Karnataka,
Villupaattu of Tamilnadu, and Kabigan of Bengal were effective in arousing the conscience of the
people against the colonial rule of British. For social change and development, modification in the be-
lief and the value systems of individuals is required, thus making them more adaptive and responsive to
organic evolution and growth.
Advantages of Folk Media
They are not only entertaining, but also offer two-way communication and are cost-effective. Print and
electronic media have limits rooted in literacy levels and accessibility; therefore, folk media can play a
crucial role in that situation. The traditional media appeal is universal, personal, and intimate. They are
popular regardless of the educational, social, and financial standing of any community. Messages that
would take months to absorb through radio and television are conveyed through a puppet show in one
evening. Since people are at ease with folk media, they relate to them better, hence making it the most
effective means of communicating mass messages.
4.3.7. Advantages and Disadvantages of Mass Communication

Advantages of Mass Communication
❑❑ High reach in short period
❑❑ Reaches to many people easily
❑❑ Low cost per person reach
❑❑ Information can be relayed quickly in times of crisis
❑❑ Uniformity in message is maintained
❑❑ Effective in altering knowledge, attitude, belief, and skills of masses
Disadvantages of Mass Communication
❑❑ It can be expensive and cost a lot to get started
❑❑ It requires significant upfront research
❑❑ Difficult to make messages specific to local community
❑❑ Can be easily misunderstood
❑❑ Centrally produced media programmes suffer from the major drawback of not taking into account
the specific local needs of different communities
A research study evaluated the effect of a mother’s exposure to electronic mass media on knowledge
and use of prenatal care services, using data from India’s 1998–1999 national family health survey. The
results indicated that exposure to mass media is related to the increased use of prenatal care services.
Effect was stronger in northern states as compared to southern states of India.
5. HEALTH EDUCATION IN INDIA

Central Health Education Bureau
It is the apex institution for health education in India. The bureau was set up in 1956. It still continues to
share up-to-date information on health education including communication and training.
Chapter 13.indd 287 5/18/2012 11:53:18 AM

The main objective of the bureau is to design guide and conduct research in health behavior, health
education programme, and aids as well as to produce and distribute “type” health education material in
relation to various health problems and programmes. It also aims to provide guidelines for the organiza-
tional set-up and functioning of health education units at the state, district, and other levels.
The bureau seeks to achieve its objectives through the seven technical divisions namely, training,
media, editorial, health education services, research and evaluation, field study and demonstration
centre, and school health education division.
The health education service division renders technical guidance to state health education bureau
and strengthens their activities. It assisted in developing health education programmes and materials to
government and nongovernment agencies in the promotion of health education.
The school heath education division promotes health education in the school system of education in
the country. It developed and revised curricula from primary to higher secondary level through health
education material. It coordinates with NCERT and CBSE for inclusion of health education subjects in
formal and nonformal education.
CHEB maintains a film library and about 750 films on different topics for teaching and educational
purposes are available on loan to agencies within and outside Delhi. On an average, six to eight films on
health problems are produced each year by CHEB in collaboration with the film division of the ministry
of information and broadcasting.
Information, Education, and Communication
Information, Education, and Communication plays a pivotal role in creating awareness, mobilizing
people, and making development participatory, through advocacy and by transferring knowledge, skills,
and techniques to the people.
Three-Tier Approach
The IEC division of the ministry of health and family welfare government of India has the overall re-
sponsibility for planning major IEC activities and national campaigns. The implementation is largely
carried out by the states and union territories, various media units of ministry of information and broad-
casting, and professional agencies. The district becomes the focal point for local IEC campaign as well
as a subcentre of activities in the surrounding rural areas.
Decentralized Strategy
An important initiative of the new IEC strategy is to decentralize IEC efforts to the level of district, so
that every district is able to plan and implement local specific IEC, keeping in view the cultural, ethnic,
and linguistic requirements with a thrust on folk media, design and display of posters, wall writing,
paintings, and specific cultural medium in their respective areas.
6. ROLE OF THE HEALTH EDUCATOR

A health educator is “a professionally prepared individual who serves in a variety of roles and is specifically
trained to use appropriate educational strategies and methods to facilitate the development of policies, pro-
cedures, interventions, and systems conducive to the health of individuals, groups, and communities” (Joint
Committee on Terminology, 2001). Areas of responsibilities of the health educator are discussed below.
Assesses Individual and Community Needs for Health Education
❑❑ Determines what health problems might exist in any given group
❑❑ Determines community resources available to address the problem
Chapter 13.indd 288 5/18/2012 11:53:19 AM

❑❑ Encourages the population to take ownership of their health problems

❑❑ Carefully collects data and analysis
Plans Health Education Strategies, Interventions, and Programs

❑❑ Develops goals and objectives which are specific and measurable
❑❑ Develops interventions that will meet the goals and objective
❑❑ Implements health education strategies that are sufficiently robust, effective enough, and have a
reasonable chance of meeting stated objectives
Implements Health Education Strategies, Interventions, and Programs

❑❑ Implementation is based on a thorough understanding of the priority population
❑❑ Utilizes a wide range of educational methods and techniques
Conducts Evaluation and Research Related to Health Education

❑❑ Depending on the setting, utilizes tests, surveys, observations, tracking epidemiological data, or
other methods of data collection
❑❑ Health educators make use of research to improve their practice
Administer Health Education Strategies, Interventions, and Programs

❑❑ Administration is generally a function of the more experienced practitioner
❑❑ Involves facilitating cooperation among personnel, both within and between various health
programs
Serves as a Health Education Resource Person

❑❑ Involves skills to access the needed resources and establishing effective relationships
Communicates and Advocates for Health and Health Education

❑❑ Translates scientific language into understandable information
❑❑ Addresses diverse audience in diverse settings
❑❑ Formulates and supports rules, policies, and legislation
❑❑ Advocates for the profession of health education
Chapter 13.indd 289 5/18/2012 11:53:19 AM

CHAPTER HIGHLIGHTS
❑❑ Health behavior refers to the actions taken by an individual to attain, maintain, and regain good
health and to prevent illness which is shaped by the health beliefs of a person.
❑❑ Factors that contribute in the development of health behavior of a person are thoughts and feel-
ings, knowledge, beliefs, attitude, value, and culture.
❑❑ Self-efficacy is an important concept that operates in the process of behavior change. By self-
efficacy, we mean a person’s impression of his/her own ability to perform a task that is challeng-
ing or demanding in nature.
❑❑ The HBM was developed in the 1950s by the United States Public Health Service to explain the
lack of public participation in health screening and prevention programs.
❑❑ The key variables of the HBM are perceived threat, perceived benefit, perceived barriers, cues to
action, and self-efficacy.
❑❑ Social learning/social cognitive theory proposes that there are a number of factors affecting
behavior change which includes environmental, personal, and behavioral elements.
❑❑ Theory of reasoned action hypothesized that human beings are rational. It proposes that before per-
forming the particular type of behavior, an individual consider the consequences of that behavior.
❑❑ Theory of planned behavior proposes that the behavior performance is proportional to the amount
of control an individual possesses over the behavior as well as to the strength of the individual’s
intention in performing the behavior.
❑❑ Transtheoretical/stages of change model proposes that behavior change is not an abrupt process;
rather it is a gradual process that takes place over the period of time. The stages of behavior
change include precontemplation, contemplation, preparation, action, and maintenance.
❑❑ The Joint Committee on Health Education and Promotion Terminology, 2001, defined Health
Education as “any combination of planned learning experiences based on sound theories that pro-
vide individuals, groups, and communities the opportunity to acquire information and the skills
needed to make quality health decisions.”
❑❑ Health communication and health education are the terms that are used interchangeably. By health
communication, we mean outward and downward communication of health knowledge to the
audience.
❑❑ The main purpose of health education is promotion of health and prevention of disease and early
diagnosis, management, and referral.
❑❑ Planning of health education is based on the need of an individual or group for health education.
Decision has to be made regarding what the desired change in health behavior should be, where
the health education should take place (ward, school, community), and how it should be done.
❑❑ There are two approaches to health education: individual and group approach.
❑❑ Principles of health education include principle of motivation, principle of interest, principle
of participation, principle of comprehension, principle of reinforcement, principle of learning
by doing, principle of known to unknown, principle of simple language, and principle of role
model.
❑❑ Mass communication occurs when a small number of people send message to a large anonymous
and usually heterogeneous audience through the use of specialized communication media.
❑❑ Television, radio, puppet show, newspaper, other print media, outdoor media, and folk media are
some of the important mass media.
Chapter 13.indd 290 5/18/2012 11:53:19 AM

❑❑ Central health education bureau is the apex institution for health education in India. The bureau
was set up in 1956.
❑❑ The bureau seeks to achieve its objectives through the seven technical divisions namely, training,
media, editorial, health education services, research and evaluation, field study and demonstration
centre, and school health education division.
❑❑ A health educator is “a professionally prepared individual who serves in a variety of roles and is
specifically trained to use appropriate educational strategies and methods to facilitate the develop-
ment of policies, procedures, interventions, and systems conducive to the health of individuals,
groups, and communities.”
EVALUATE YOURSELF
Q 1: Define health education? What are the principles of health education? Explain the role of com-
munity health nurse in health education (NTRUHS, 2010)?
Q 2: Discuss a blueprint to communicate message on HIV/AIDS prevention and specify the target
group, the type of media to be used, and the method of collecting feedback (NIMS, 2008).
Q 3: Discuss the importance of IEC in Indian context (NIMS).
Q 4: List the different types of mass media used in health education (RGUHS, 2010).
Q 5: Write a short note on the methods of health education (BFUHS, 2010).
Q 6: Plan and conduct a health education session on “Immunization” schedule for a group of commu-
nity people (BFUHS, 2008).
Q 7: Write a short note on the planning of health education (RUHS, 2008).
Q 8: Write a short note on the use of mass media (RGUHS, 2009).
Q 9: Write a short note on the importance of health education.
Q 10: Explain the components of health education and discuss briefly the aims of health education?
1. McKenzie J., Neiger B., Thackeray R. (2009). “Health Education and Health Promotion. Plan-
ning, Implementing, & Evaluating Health Promotion Programs”, 5th edition, San Francisco, CA:
Pearson Education, Inc. pp. 3–4.
2. Donatelle R. (2009). “Promoting healthy behavior change. Health: The basics”, 8th edition, San
Francisco, CA: Pearson Education, Inc. pp. 4.
3. Brieger WR, Edozien E. (1982/3). Pioneering patient education in Nigeria. Africa Health, Decem-
ber/January, 27–29.
4. Byram ML. (1980). Popular theatre as appropriate media. Appropriate technology, 7, 21–22.
5. Werner D, Bower B. (1982). “Helping health workers learn”, Palo Alto California: Hesperian
Foundation.
6. Moynihan M, Mukherjee U. (1981). Visual communication with non-literates: a review of current
knowledge including research in northern India. Int J Health Educ, xxiv, 251–261.
7. Jenkins J. (1983). “Mass media for health education”, Cambridge: International Extension
College.
Chapter 13.indd 291 5/18/2012 11:53:19 AM

8. Schwarzer R. (2008). Modeling health behavior change: How to predict and modify the adoption
and maintenance of health behaviors. Applied Psychology: An International Review, 57(1), 1–29.
9. Ajzen I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl and J. Beckman
(Eds.), “Action-control: From cognition to behavior”, Heidelberg, Germany: Springer. pp. 11–39.
10. Bandura A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological
Review, 84, 191–215.
11. “Behavior Change – A Summary of Four Major Theories.” Family Health International. 16
November 2007.
12. Nutbeam D. (2000). Health literacy as a public health goal: a challenge for contemporary health
education and communication strategies into the 21st century. Health Promotion International,
15(3), 259–267.
13. Skinner B.F. (1953). “Science and Human Behavior”, New York: Free Press.
Chapter 13.indd 292 5/18/2012 11:53:19 AM

c h a p t e r 14
Guidance and Counseling
1. INTRODUCTION
Human beings cope with a number of personal and other problems in all walks of their day-to-day life.
Capabilities to solve personal, social, vocational, and moral problems vary from individual to individual,
and sometimes they require assistance to overcome these problems from their grandparents, parents,
other relatives, and professional counseling service providers.
Similarly, any school or college of nursing is a miniature of this complex society where students
from different backgrounds, cultures, and regions live together. A student can face a number of prob-
lems in campus as well as out of campus life for which he/she seeks advice from his/her teachers or
family members. Counseling explores the possible solutions for a given problem situation, and further
it depends on the counselee which solution he or she has to adopt.
Nursing undergraduates may have a number of doubts, queries, and problems related with their
future, carrier, academic difficulties, learning difficulties, and employment for which they need guid-
ance from their teachers, who have to show them the right path to succeed in their life as per their
potential. Guidance is a type of assistance provided to the students so that they can develop a positive
self-concept, can develop an effective relationship with colleagues, can solve their academic as well
personal, social, and moral problems, and can develop an understanding of current and potential educa-
tional or carrier alternatives available to them. Therefore, guidance and counseling services are impor-
tant facilities that should be made available in a nursing institute. Let us see what is the actual meaning
of guidance and counseling, which are the different sides of the same coin.
2. GUIDANCE
2.1. Meaning and Definition
The emergence of guidance is as old as human society. It is found in all walks of life in home, in
business, in industry, in government, in social and personal life, in hospitals, and in prisons; indeed it is
present wherever there are people who need help or who can help. It is the help given by one person to
another person in making selections, choices, as well as adjustments. It has more to do with something
that you are not sure of or something that you don’t know about and you have someone familiar and
more experienced to explain it to you.
It is a broad concept that includes counseling in it; in other words, counseling is a specialized and
individualized part of guidance services. Thus, all counseling is guidance but all guidance is not coun-
seling. It is program of services designed to assist students in developing a positive self-concept, an
effective relationship with others, problem-solving skills that are necessary to function effectively in
Chapter 14.indd 293 5/18/2012 11:53:43 AM

any academic program or to live in society, and an understanding of current and potential educational
or carrier alternatives.
It is a process of helping an individual to discover his/her own potentialities, capacities, capabili-
ties, abilities, and aptitudes so as to help him/her in making the best use and development of these
qualities.
Some psychologists and educationist have defined guidance as follows:
“Guidance is the systematic professional process of helping the individual through education and
interpretive procedure to gain a better understanding of his own characteristics and potentialities
and to relate himself more satisfactorily to social and personal requirements and opportunities
according to social and moral values.”
—Mathewson
“Guidance is that aspect of educational programme which is concerned especially with helping
the pupil to become adjust in his present situation and to plan their future as per his interest,
abilities and social needs.”
—Erickson
“Guidance is an assistance made available by a competent counselor to an individual of any age

to help him to direct his own life, develop his own point of view, make his own decision and carry
his own burden.”
—Crow and Crow
“Guidance is a service designed to help one individual or group of individuals in making necessary
adjustments to environment whether that be within the school or outside it.”
—Proctor
According to the Manual of Educational and Vocational Guidance published by the Ministry of
ducation Stoops, “Guidance is the process of assisting the individual to choose, prepare for, enter upon
E
and progress in course of action pertaining to the educational, vocational, recreational and community
service group of human activity” (Figure 14.1).
2.2. Types of Guidance

Every individual has different strengths and limitations; some or the other time of life they need help to
become happier, more creative, and better adjusted in social, family, and academic life. On the basis of
the requirement of guidance by an individual, it is divided into the following:
2.2.1. Educational Guidance

Educational guidance is provided to a student to assist him/her in the selection of right educational
stream, to overcome academic problems and learning difficulties, and motivate him/her to pursue
the right educational path as per his/her interest, strength, or potential. It also helps the individual to
overcome learning difficulties, foster creativity, and increase the level of motivation.
Chapter 14.indd 294 5/18/2012 11:53:43 AM

Guidance and Counseling | 295
D-Developmental
A-Applicable and and comprehensive
practical in nature in nature
I-Based on individual
N-Never ending and not differences
a past process
C-Individually centered
U-Universal (meant for
process
pupil of all the stages)
E-Based on rigid codes G-Generalised, organised

Guidance and specialised service
of ethics
having specific purpose
Figure 14.1 Meaning of Guidance
2.2.2. Vocational Guidance

It is a type of carrier guidance in which students are assisted in the selection of the right vocational car-
rier, employment and carrier opportunities, future scope and carrier growth by providing them related
information so that students can make the right decision according to their resources and capabilities.
2.2.3. Social Guidance

Social guidance assists an individual to live with his/her full capacitates in the social environment,
confirm to the social norms, develop healthy and positive social relationship, and regulate his/her social
behavior and attitude so that he/she can better adjust within and outside the school and college campus
and become an efficient citizen.
2.2.4. Personal Guidance

Personal guidance is provided to an individual student to assist him/her to overcome his/her personal
problems and adjust with the school or college environment. It also assists the student to become pro-
gressively responsible for his/her own development, thus helping him/her to solve their emotional,
social, ethical, and moral problems.
2.2.5. Advocational Guidance

It is the assistance to be provided to students to spend their available leisure time profitably. Activities and
programmes outside the formal classrooms provide many opportunities for the student to increase their talent.
2.2.6. Health Guidance

Assistance is provided to the students to understand the need for sound health, which enables them
to appreciate conditions for good health and take necessary steps to ensure good physical and mental
health (Figure 14.2).
Chapter 14.indd 295 5/18/2012 11:53:43 AM

Educational
Health Social
Types of
Guidance
Advocational Vocational
Personal
Figure 14.2 Types of Guidance
3. PURPOSE OF GUIDANCE
❑❑ It helps the students in making appropriate adjustments to the academic environment (educational
institution) and occupational world in the home and community.
❑❑ It helps in professional and individualized adjustment in the current situation.
❑❑ It helps in identifying the individual student problem and explores the different areas of solution
with the student for that problem.
❑❑ It helps in orienting the student in the problem of career planning, educational programming, and
direction toward long-term personal aims and value.
❑❑ It contributes to the self-development and self-realization of the student while furthering the
welfare of society.
4. PRINCIPLES OF GUIDANCE
Hollis and Hollies have suggested some principles of guidance that should be observed for effective
delivery of guidance services or programmes. These are:
1. The dignity of the individual is supreme; therefore it should be given top priority.
2. Each individual is different from every other individual.
3. Primary concern of guidance is the individual in his/her social setting.
4. The attitude and personal perceptions of the individual are the basis on which he/she acts.
Chapter 14.indd 296 5/18/2012 11:53:43 AM

5. The individual generally acts to enhance his/her perceived self.

6. The individual has the innate ability to learn and can be helped to make choices that will lead to
self-direction consistently with social improvement.
7. The individual needs continuous guidance process from early childhood through adulthood.
8. At times an individual may need the information and personalized assistance by competent personnel.
5. NEED FOR GUIDANCE

The need for guidance is universal. It is not confined to a few individuals or few areas. It is needed
because of:
❑❑ Unstatic and complex nature of the society: Rapid urbanization and industrialization have made
the society very complex and intricate, leading to a number of issues and problems.
❑❑ Welfare of the individual and society: Providing better scope for the individual to improve and
express himself/herself as an able person, thus helping the individual in self-development and
self-realization.
❑❑ Changed industrial and educational pattern of the country: The problems of selection of subjects,
vocations of formidable problem, and the education and industrial system in the absence of the
guidance service will not progress satisfactory.
❑❑ Conservation of human energy: Helps the individual to make the right use of leisure time and
prevent social problems. It also acts as an instrument for the qualitative improvement of education
and national development.
❑❑ Academic growth: Helps in the development of abilities and skills consistent with varying capaci-
ties of the individual and removal of subject matter difficulties.
❑❑ Personal and social development: Self-understanding and proper adjustment to self and society is
required for better family life, the right attitude toward home, and understanding of relations of
social values, needs, and problems.
6. COUNSELING
Guidance and counseling are not synonymous terms. Counseling is a part of guidance or it is a specialized
service of guidance. It is an accepting, trusting, and safe relationship in which client learns to discuss
freely what upsets him/her.
6.1. Meaning and Definition

Counseling involves more precision and depth in its approach as compared to guidance. It is
a method that helps the client to use a problem-solving process to recognize and manage
stress that in turn facilitates interpersonal relationship among client, family, and health care
team.“Counseling is a process through which one person helps another by purposeful conversation
in an understanding atmosphere. It seeks to establish a helping relationship in which the one
counseled can express their thoughts and feelings in such a way as to clarify their own situation,
come to terms with some new experience, see their difficulty more objectively, and so face their
problem with less anxiety and tension. Its basic purpose is to assist the individual to make their
own decision from among the choices available to them”
—British Association for Counselling, Rugby, 1989.
Chapter 14.indd 297 5/18/2012 11:53:43 AM

“Counselling is mental learning process which involves two individuals, one seeking help and
other a professionally trained person helping the first to orient and direct him towards a goal
which leads to his maximum development and growth in his environment.”
—Willy and Andrew
“Counselling is a personal and dynamic relationship between two individuals—an older, more
experienced and wiser (counselor) and a younger, less wise (counselee). The latter has a problem
for which he seeks the help of the former. The two work together so that the problem may be more
clearly defined and the counselee may be helped to a self-determined solution”
—Wren (1962)
“Counseling is the helping relationship that includes some one seeking help, someone willing to
give help, who is capable or trained to help, in a setting that permits help to be given and received”
—Cormier and Hackney (1987)
From the above-mentioned definitions, it can be comprehended that counseling is a process to assist
a person to make decision to solve a particular problem of interest in which the counselor’s role is to
explore the counselee’s subjective views of problem, assist him to develop more objective and realis-
tic view toward the problem situation, and accordingly explore the suitable alternatives to solve the
problem so that the person seeking help can choose the one which he/she thinks is most suitable. The
definitions as stated above encompass the following elements of counseling:
❑❑ Counseling is a type of assistance which is received by a person who is in need of it.
❑❑ Counseling involves a relationship between two persons, one who is overwhelmed with some
problem at one end (counselee) and the other who assists the person to overcome the problem—a
counselor—at the other end.
❑❑ Counseling helps an individual to develop objective view toward his/her problem situation.
❑❑ Professional counseling is never given; it is always taken by a person who is in need of it.
❑❑ Counseling does not mean solving the problems of others.
❑❑ Counseling is a personalized process, which depends upon the dynamics of interpersonal relationship.
❑❑ Counseling changes the attitudes and behaviors of a person and makes him/her more confident in
dealing with problems.
Counseling can be provided by an elder family member or relatives (informal counseling), as a part
of professional work of some persons like nurses and social workers (nonspecialist counseling), and by
a fully trained person known as counselor who has obtained master’s or PhD degree in psychology or
guidance and counseling (professional counseling).
6.2. Need for Counseling Services

Nursing education as well as nursing profession is unique as compared to other educational and
workplace settings. Because of this uniqueness of the nursing education and nursing profession, guid-
ance and counseling services are required in nursing educational institutions and nurse’s workplace.
Let us discuss these important issues which demand for guidance and counseling services at colleges of
nursing as well as workplace of nurses.
Chapter 14.indd 298 5/18/2012 11:53:43 AM

6.2.1. Need of Counseling in General

❑❑ Changing conditions of home: Rapid urbanization, industrialization, and nuclear family have
given rise to multiple problems.
❑❑ Technological explosion: Machines, electricity, computer, and transportation system are rapidly
advancing in the 21st century. A person cannot keep pace with this technological advancement
and may be trapped in problems.
❑❑ Rapidly changing educational system: Flood of new courses makes a student confused to make
the selection of the right course and future scope of the same for him/her.
❑❑ Changing moral and religious conditions of the present cosmopolitan society, for instance, live-in
relationship; honor killings have given rise to a number of social problems.
❑❑ Changing corporate philosophy to make more and more profit and paying less and less to the
employees.
❑❑ Appeal of pseudo-sciences: numerology, calligraphy, and astrology, making a person confused to
make decisions.
❑❑ Changing conditions of labor and industry: More skilled workers are required.
6.2.2. Need at Nursing Educational Institution

❑❑ Long-duty hours: Nursing students are supposed to perform long duties in clinical areas as per
their curriculum requirement. Initially, the students may feel difficulty to adjust with the situation
and may experience maladjustment with the situation.
❑❑ Hostel life: Nursing students have to live in nursing hostel with other colleagues. There may be
a number of problems associated with hostel life, ranging from mess problems to lack of sleep
because of different preferences of personal study hours among roommates. These problems
make a student perplexed; therefore he/she requires guidance and counseling to solve these
problems.
❑❑ Night duty: Students are posted for 12 hours night duty; thereafter, they are supposed to attend
morning classes. This change in sleep cycle may disturb the life of a student and he/she may feel
burned out.
❑❑ Personal problems: There may be a number of personal problems among nursing students
ranging from love affair, love failure (the most common problem among bachelor students) to
difficulty in understanding the contents and chronic illness. Nursing undergraduates are quite
immature to deal effectively with these personal problems; therefore, provision of guidance and
counseling services is required at the institutional level.
❑❑ High pressure of study: The curriculum is vast and complex which puts high pressure of study
on the students to obtain good marks in the exams.
❑❑ Altered sex ratio: A majority of the students are female and the entry of male is limited. Hence,
male students may have adjustment problem with the female colleagues as well as they may feel
isolation throughout the course of study.
❑❑ Family problems: Family problems may affect the academic performance of the students.
❑❑ Dealing with life and death situation: Nursing profession is based on the principle of caring of
sick and well. In the clinical area, students witnesses the death of patients and crying relatives.
Young students are not mature enough psychologically to deal with these situations and may
require guidance and counseling support.
Chapter 14.indd 299 5/18/2012 11:53:43 AM

❑❑ Getting experience not fit for age: Young immature students are exposed to certain experiences
which are quite unexpected in young age, for example, putting folly’s catheter, witnessing de-
liveries, observing major surgeries, and so on. Some students cannot cope up with the situation
initially and are in need of guidance and counseling services.
❑❑ Playing role as staff nurses: In most of the private nursing institutions, nursing students are
misused as staff nurses. They are assigned such responsibilities in clinical areas for which their
shoulders are quite young and immature.
❑❑ Lack of provision of stipend: In private colleges and schools of nursing, students are not paid
stipend which may cause dissatisfaction among them and may demotivate them to learn and work
in clinical area.
❑❑ Suicide: Nursing students are more stressed with their academics along with other problems
which sometimes may push a student to commit suicide to get rid of these problems. In the past,
there are a number of suicidal cases of nursing students in India, which emphasize the need of
counseling services in college itself so that precious lives can be saved.
6.2.3. Need of Counseling Services at Nurses’ Workplace Setting

❑❑ Personal problem: As mentioned previously personal problems are part and parcel of day-to-day
life of every nurse which may affect job performance and thereby the performances of health care
organization.
❑❑ Increasing healthcare costs: Health care costs are rising day by day with the increasing level of
inflation. Hence, reducing lateness, absenteeism, and losts time with the help of guidance and
counseling services can save money for a health care organization. Reducing turnover can im-
prove productivity and the bottom line.
❑❑ Vulnerability of nurses is higher for feeling stressed out due to:
❑❑ They need to act as mother, home manager, and teacher as well as manage critical situations
in the high-pressure clinical setting.
❑❑ Hostel-type accommodation provided to nurses by employers leads to problems of adjustment
with the hostel and mess.
❑❑ Higher workload (nurse–patient ratio).
❑❑ Generalized training (most of the nurses) but specialized job settings.
❑❑ Poor working conditions.
❑❑ Increased expectations of patients.
❑❑ Unfair remunerations to nurses.
❑❑ Round-the-clock duty leads to disorganized life of a nurse.
❑❑ Difficulty in getting leaves sanctioned leading to problems in family life.
❑❑ Less qualified supervisors (no value to higher degrees).
❑❑ Promotions issues: Promotion on the basis of experience only, no value of higher qualifications.
❑❑ Inability to meet job demands, over workload, confrontation with authority, responsibility,
and accountability.Conflicts with superiors, subordinates, and management as well as vari-
ous family problems, health problems, career problems, alcohol, or substance abuse may
bewilder a staff nurse.
❑❑ Emotional problems, family or marital difficulties, financial or legal situations, workplace stress.
Chapter 14.indd 300 5/18/2012 11:53:44 AM

6.3. Purposes of Guidance and Counseling Services

❑❑ Helping the students to adjust properly in the academic environment of the college as well as in
the professional and personal life
❑❑ To guide the student to adjust with the pressure of increased studies
❑❑ To identify and provide solutions for learning problems faced by students
❑❑ To help the student to explore his/her strength and weakness and channelize his/her energy to the
right direction
❑❑ To provide carrier advice to the students regarding carrier planning, job planning, employment,
and higher education
❑❑ To encourage self-development and self-realization of the student
❑❑ Effective solutions to personal and interpersonal problems to make proper adjustment in a given
situation
❑❑ Overcoming and managing self-defeating emotions
6.4. Scope of Guidance and Counseling

The scope of guidance and counseling is unlimited, and we require it in every walk of our life. Every
individual requires guidance at various developmental stages of his/her life for smooth transition of
growth and development, from nursery and kindergarten to college education even beyond of this for
choosing carrier, and to progress within a job setting. Given below is a list of some important areas
which are more frequently referred as scope areas of guidance and counseling.
❑❑ Selection of educational course, placement in the next level of education and training
❑❑ Job placement, carrier opportunities, future planning
❑❑ Personal problems
❑❑ Educational problems
❑❑ Vocational problems
❑❑ Moral problems
❑❑ Social problems
❑❑ Physical problems
❑❑ Marital problems
6.5. Difference Between Guidance and Counseling

Table 14.1 depicts the differences between guidance and counseling.
6.6. Principles of Counseling

❑❑ Human dignity: Every individual is different and represents personal values and traditions. Therefore,
maintaining human dignity and accepting individual differences are primary concern of counseling
process, and the counselee should not be made to feel inferior and subject to disrespectful behavior.
❑❑ Hold personal values: A counselor should be aware of his/her personal values and beliefs and
should not impose the same on the counselee because few things the counselor may view as unim-
portant may be of paramount importance to the counselee. Therefore, keeping the personal values
on hold is important for the counselor which enables him/her to show empathy to the counselee.
Chapter 14.indd 301 5/18/2012 11:53:44 AM

TABLE 14.1 Difference Between Guidance and Counseling

Counseling Guidance
It helps with considering all sides of a potential Guidance is the process that is put in place at a
choice even before the choice is made time a choice is to be made
Counseling strictly observes the ethical principle of Guidance may or may not focus on confidentiality
confidentiality issue
It is an individualized, specialized process with a high It is a broad and comprehensive process
level of precision and depth
Counseling is a part of guidance, not all of it Guidance is a term which is broader than
counseling and which includes counseling as one
of its concept
Counseling is more focused on social, personal, and Guidance mainly focuses on educational and
emotional problems of a person vocational problem of a person
Counseling is usually given for the abnormal Usually guidance is given to a normal individual
behavior
It is always personal It can be personal or impersonal
Changes are brought about in the feeling and Changes are brought in educational and
emotions of the individual vocational preferences of the individual
❑❑ Assist the client to make decision: A counselor is not required to make decision for the client, but
he/she has to develop an objective view toward the problem situation with the help of client as
well as explore the available alternatives for a given problem situation and assist the counselee to
choose one as per his/her strength and willingness. It is strongly dedicated to self-direction and
self-realization of the client or the student.
❑❑ Nonjudgemental: Be nonjudgmental, as a counselor you are not a judge.
❑❑ Confidentiality and privacy: Maintaining confidentiality and privacy is one of the important and
ethical principles of professional counseling.
❑❑ Voluntary: Professional counseling is never given, but it is always voluntarily sought by an
individual who is in need of it.
❑❑ Relationship: Relationship of trust and confidence between counselee and counselor is of
paramount importance, upon which all the success of counseling process depends.
❑❑ The client’s family members and significant others must be included in counseling process.
6.7. Steps in the Counseling Process

Counseling is a systemic process and takes place in accordance with the nature of the person being
helped. The process passes through different steps, which may sometimes overlap each other, for
example, the assessment step may begin with the step of establishing the relationship.
6.7.1. Establish Trustworthy Relationship

One should recognize that each counselee–counselor relationship is unique. Establishment of trustworthy
relationship with counselee is vital without which the process of counseling cannot be initiated suc-
cessfully. Factors such as respect, trust, and sense of psychological comfort should be considered
Chapter 14.indd 302 5/18/2012 11:53:44 AM

while initiating the process of counseling. The following skills are required to establish a trustworthy
relationship with the counselee:
❑❑ Begin the phase with adequate social skills.
❑❑ Introduce yourself.
❑❑ Listen attentively.
❑❑ Always address the individual by his/her name.
❑❑ Ensure physical comfort.
❑❑ Do not interrupt the counselee while she/he is talking.
❑❑ Observe nonverbal communication.
❑❑ It may require a series of sessions before the counselee becomes comfortable with the counselor.
6.7.2. Assessment
This is the step in which the counselee explores his/her feelings, problems, and concerned area. The
counselor encourages the counselee to express his/her perspective toward the problem situation and the
emotional upsets experienced by him/her. The counselor should help the counselee to put their concern
into words whenever he/she is facing difficulty in doing so. The role of the counselor in this phase is
to develop an objective outlook of the problem so that possible interventions can be generated. Several
specific skills are required for effective assessments which are as follows:
❑❑ Active listening: find out the client’s agenda
❑❑ Paraphrase, summarize, reflect, interpret
❑❑ Focus on feelings, not events
❑❑ Keen observation
❑❑ Making intelligent guesses
❑❑ Systematic and prompt recording of information
6.7.3. Setting Goals

The counselor and counselee work together to set immediate and ultimate goals based on the data
collected in the assessment phase. Problem statements are transformed into goal statements. Goal
setting helps the counselor to know how well counseling is working. The process of setting goals is
cooperatively done by the counselor and the counselee. It requires:
❑❑ The skills of drawing inference and differentiation.
❑❑ Teaching the individual to think realistically.
However, it should be realized that goals are not fixed and can be changed whenever new information
is received.
6.7.4. Intervention
The intervention will depend upon the approach of counseling used by the counselor, the problem, and
the counselee. The choice of the intervention is in fact a process of adaptation, and the counselor should
be prepared to change the intervention when the selected intervention is not working.
6.7.5. Termination and Follow-Up

The counselor summarizes what has occurred, clarify, and get verification from the counselee. Termination
of the counseling session is done without destroying the accomplishments gained and with due sensitivity.
Chapter 14.indd 303 5/18/2012 11:53:44 AM

Establish trustworthy relationship
Assessment
Setting goals
Intervention
Termination and follow-up
Figure 14.3 Steps in Counseling Process
The counselor may plan to get feedback and follow-up appointment with the counselee at regular intervals
if required. As a counselor, one should keep in mind that first session is the last session (Figure 14.3).
6.8. Types of Counseling Approaches

Most of the available literature on guidance and counseling have described three types of counseling
approach which are as follows:
6.8.1. Directive Counseling or Counselor-Centered or Clinical Counseling

E.G. Williamson termed the directive counseling as the clinical method. This approach is also known
as authoritarian or psychoanalytic approach of counseling. As the name suggests, the counselor plays
a more active role and directs the process without violating the principles of counseling. He assists
the counselee in making decision and finding solutions to the problem. This approach of counseling
assumes that the counselor is more competent than the counselee, and counseling is primarily an intel-
lectual rather than emotional process. Hence, counselor should play an active role to direct the process.
No individual can overcome his own bias in viewing himself; the counselor can see a client
more objectively than the client himself can see
—Williamson
The main advantages of this approach are that it is economical in time and emphasizes the problem
not the individual enabling the counselor to see the counselee more objectively. The disadvantage of this
approach is that the counselee becomes overdependent on the counselor.Williamson has suggested five
steps of this approach of counseling, which are depicted in Figure 14.4.
Chapter 14.indd 304 5/18/2012 11:53:44 AM

Clinical Analysis: Collection and analysis of data pertaining to problem of interest
Diagnosis: Finding the possible causes of the problem
Prognosis: Envisaging the development of the problem
Counseling: This is the central part of the process in which the counselor discusses
issues with the counselee so that he/she can develop insight into the problem situation
Termination and follow-up
Figure 14.4 Steps of Directive Counseling Process
6.8.2. Nondirective Counseling Approach

Carl Roger, the leading exponent of this counselee-centered or client-centered approach of counseling
advocated that within every individual there are growth forces which, if released from all restrictions,
will help the individual to make adjustment with his/her environment. Therefore, the role of counselor
should be relatively passive, and the client has to take the responsibility of exploring his/her problem
situation. The counselor should neither agree nor disagree with the client but shows friendliness and
receptive attitude. The principles of acceptance and tolerance are extremely important on the part of the
counselor. In the beginning of the process, the counselor defines his/her limitations of the responsibilities
and encourages the client to explore everything which is causing trouble to him/her. This approach puts
due emphasis on the individual and his/her potentials and is based upon the fundamental respect for the
individual; belief in the person’s ability to solve personal problem with the aid of sympathetic listener.
It works on:
1. To facilitate the development of self-insight component
2. Release of tension
3. The client has to be led to a point of self-realization, self-actualization, and self-help.
Steps of nondirective counseling approach are:
1. Establishing rapport
2. Exploration of the problem
3. Exploration of the cause of the problem
4. Find out alternative solution
5. Termination of the session
6. Follow-up
Chapter 14.indd 305 5/18/2012 11:53:44 AM

Man has dignity, so he is trustworthy; the client has the right to select the goal of his life
—Carl Roger
This method is useful in solving educational, vocational, and marital problem, and the counselor has
the respect for the personal autonomy of the client.
This approach is limited in several ways as mentioned by Arbuckle that some individuals are unable
to express themselves by nature; some may be hostile to get outside help; the client may have inferiority
complex, anxiety, and low IQ and hence feel inexpressive in front of the counselor. In these situations,
it may not be a suitable approach for counseling.
6.8.3. Eclectic Approach of Counseling

Eclectic approach is based on the fact that all individuals differ from one another; therefore, no single
approach can be applied to each and every problem. The counselor should make use of both direc-
tive and nondirective approaches as per the requirement which may be more useful for the purpose of
modifying the ideas and attitude of the client.
This approach of counseling is based on Thorne’s orientation to the theory and practice of personality
counseling that emphasize that counselor should be competent to use all available methods or resources.
Since both the approaches (directive and nondirective) have some limitations and are rival to each other
in their practical application, some psychologists suggested this middle way to both approaches. It sug-
gests that the counselor should first take into consideration the personality, age, sex of the client, as well
as the type of problem; thereafter, he should determine the appropriate approach for counseling in that
particular situation. The role of counselor is to plan and carry out the treatment of counseling and the re-
sponsibility of developing insight into the problem and making the final decision rest on the counselee.
Eclectic approach uses five steps of counseling as suggested by Throne. These steps are depicted in
Figure 14.5.
Diagnosis of the causes of problem or maladjustment
Developing a plan to modify the causes of problem
Securing appropriate environmental conditions for the client
Encouraging the client to develop his/her own
Proper handling of the problems subsequent to adjustment
Figure 14.5 Steps of Eclectic Approach of Counselling
Chapter 14.indd 306 5/18/2012 11:53:45 AM

7. GROUP COUNSELING
It is a technique where a group of persons are counseled together through the process of group interaction
for the purpose of arriving at a solution to the problem. Group work helps the group in understand-
ing and finding out a solution to their problem. Some of the components like knowledge of reality,
self-knowledge, and self-realization can be achieved through group interaction process.
In the beginning of the group counseling session, the counselor should have some knowledge about
the interaction process and understanding of the background of the group members, knowledge of vari-
ous psychological problems, and the specific need of each participant. The process of group counseling
involves the following steps:
❑❑ Selection of the participant

❑❑ Starting the session
❑❑ Orientation toward discussion
❑❑ Checking the unwarned behavior
❑❑ Assisting in self-disclosure
❑❑ Assisting in decision-making process
❑❑ Closing of the session
❑❑ Follow-up
The participants for the group counseling are chosen on the basis of their common problem. The
ultimate phase of the group counseling is decision making which is taken by the group and acceptable
to all group members. Respect for each member is taken into consideration. After decision making, ter-
mination of the session is jointly decided by group members. When all members get satisfied with the
outcome of the session, the counselor decides to end up the session. Follow-up sessions may be planned
as and when required.
8. QUALITIES OF A COUNSELOR
❑❑ Counseling is a complex process of interaction between a counselor and counselee aimed to assist
the counselee to overcome a problem situation which he/she is not able to solve with his/her own
efforts. A counselor is a person who plays a significant role to create an objective perspective
of the client problem and suggests remedies to overcome it. Some qualities are desirable for a
counselor to succeed in the process of counseling which are listed as follows:
❑❑ Leadership: A good counselor should possess leadership qualities (the ability to lead others) to
direct and lead the process of counseling (directive approach).
❑❑ Interpersonal relationship: Interpersonal relationship is pivotal for the success of counseling;
therefore, a counselor should posses qualities of building effective interpersonal relationship,
openness, attentive and active listener, friendliness, ability to show warmth and attitude of
acceptance toward others, tactfulness, tolerance, patience, and empathy.
❑❑ Nonjudgmental: The counselor should be nonjudgmental. Making personal judgment of the
situation dilutes the aim and effectiveness of the counseling.
❑❑ Personal values: The counselor should be aware of his/her self (social, private, spiritual self),
personal values, prejudices, belief, culture, and attitude so that the counselor can put these factors
on hold to develop an objective perspective of the client’s situation.
Chapter 14.indd 307 5/18/2012 11:53:45 AM

❑❑ Communication skills: More or less counseling is a communicative process which takes place
between the counselor and counselee; therefore, a counselor must have good communication skills.
❑❑ Respect for human being: A counselor should be able to show due respect to the person being
counseled without considering cast, creed, race, culture, and personal preferences. He should be
aware of and respect a person’s individuality in terms of unique values, attributes, and skills.
❑❑ Pleasant personality: A counselor should have pleasing magnetic personality with a sense of
poise and neatness and should be free from annoying mannerisms.
❑❑ Energetic: A counselor should be highly energetic to deal with a number of clients and emotion-
ally draining and physically demanding situations which require a lot of efforts and time.
❑❑ Active listener: Active listening is an essential skill which is required for a good counselor. It
involves attentively listening to the words and observing the nonverbal behaviors and manners to
address internalized thoughts and feelings of the client.
❑❑ Intellectual competence: It is a mandatory requirement without which one cannot become a
professional counselor; although nonprofessional counselor does not require any degree or di-
ploma, they must be intellectually competent and have knowledge of many areas of interest to
handle variety of situations presented by the counselee before him/her.
❑❑ Flexibility: Flexibility means the ability to change responses as per the demand of the situation.
A counselor should not be rigid to follow the same line in all the situations; rather he/she should
be flexible enough to adopt what is workable in a given situation. For example, while counseling
a child who is relatively mute will require different counseling strategies as compared to a child
who is relatively outspoken.
❑❑ Philosophy of life: A good counselor should have a positive philosophy of life, good character, and
civic sense. He should also have a positive attitude toward life.
❑❑ Credibility and trustworthiness: Credibility can be achieved by displaying consistency and
honesty in the statements and the actions. A credible counselor is straightforward with their clients
and behaves in such a manner that their clients respect and trust their words.
❑❑ Empathetic or compassionate: Empathy means seeing the situation from the other person’s
internal frame of reference. A good counselor must have the quality to show empathy to the client
to lighten the emotional burden felt by him/her.
9. SKILLS/TECHNIQUES REQUIRED FOR EFFECTIVE COUNSELING

Counseling requires some skills on the part of the counselor to effectively counsel the client by exploring
the problem situation and suggesting alternatives for the same.
❑❑ Active Listening: Easy to describe but difficult to practice, it is the skill of listening to the client
actively and attentively while maintaining eye-to-eye contact and at the same time observing the
nonverbal behavior shown by the client. The technique of active listening includes:
❑❑ Maintaining good eye-to-eye contact with the client
❑❑ Having open posture
❑❑ Saying “carry on,” “huhuu,” “nodding the head to agree with the client statements” to
encourage the client to speak more
❑❑ Don’t make any interruption in between when the client is talking
❑❑ Ask questions whenever necessary to facilitate conversation
Chapter 14.indd 308 5/18/2012 11:53:45 AM

Active
Listening
Empathy Reflecting
Counselling
Skills
Summarizing
and Focusing
Paraphrasing
Figure 14.6 Skills Used in Counselling
❑❑ Reflecting: The counselor refers back the questions, feelings, and any other important statements
to the client so that he/she can assume that the counselor understands what he/she intends to
understand him/her.
❑❑ Focusing: Spotlighting any idea or even a single word, which seems to be significant for a given
problem situation.
❑❑ Summarizing and Paraphrasing: it is the brief restatement and rewording in own words of the main
points what the client has communicated to the counselor to clarify the meaning of message so that the
client can assume that the counselor has understood the crux of his/her problem as well as the coun-
selor becomes sure that he/she has understood what the counselee intends to communicate him/her.
❑❑ Empathy: Empathy is a skill of putting yourself into the shoe of others, means to think and feel a
particular situation from the client’s frame of reference. Empathy may be communicated verbally,
nonverbally, or by a mixture of both (Figure 14.6).
Note: Giving reassurance, rejecting, giving advice, defending, using denial are some of the
nontherapeutic communication techniques which the counselor should avoid during counseling.
10. ROLE AND PREPARATION OF COUNSELOR

For effective counseling, the counselor needs to prepare certain attitude, skills, knowledge, as well as
physical setting for counseling. The preparation of the counselor can be divided into two categories:
personal preparation and preparation of the physical settings.
Chapter 14.indd 309 5/18/2012 11:53:45 AM

10.1. Personal Preparation

❑❑ Self-awareness: Counselor should be aware of self-prejudice, biases, feelings, value, motivation, per-
sonal strength, and weakness. He should not have influence of these factors on the counseling process.
❑❑ Physical appearance and health: The physical appearance of counselor is very important for
successful counseling. YAVIS Young, Attractive, Verbal, Intelligent, and Successful counselor is
more effective. He should be physically fit.
❑❑ Psychological health: A good state of psychological health is required to be a good counselor. A
counselor should be mentally healthy in all the aspects, aware of one’s limitation, flexibility, and
adaptability should be present in his behavior.
❑❑ Sensitivity: A person who is aware of resources, limitation, and vulnerability of other persons as
well as is keen observant to other person’s feelings and needs is considered to have sensitivity.
❑❑ Open mindedness: A counselor should prepare himself/herself to accept the ideas or information
openly from the counselee without imposing any judgment and influence of own personal values.
❑❑ Trustworthiness: A counselor should be reliable, honest, and maintain confidentiality of the
information.
❑❑ Approachability: A counselor should be approachable. He should be friendly, pleasant, and can be
approached without a feeling of apprehension.
10.2. Physical Preparation

Counseling can occur almost anywhere, but comfortable physical settings promote the process better
than others. Some of the physical conditions involved in counseling as mentioned by Benafamin and
Snertzer are:
❑❑ The environment should be calm, quite, comfortable, soothing, and aesthetic. There should not be
distracting stimuli that can disturb the process of counseling (switch off mobile phones, cut off
the phone lines).
❑❑ There should not be a table (desk) between counselor and counselee as it can create barrier in the
development of trustworthy and close relationship. If required, a desk can be placed at the side of
the counselor to place tissue paper, glass of water.
❑❑ The distance of sitting between counselor and counselee can have significant effect in the
development of rapport. The distance should not be so close and so far, but it should be main-
tained at the comfort level of the counselee which is determined by some variables such as cul-
tural background, gender, and age. Distance of 30 to 39 inches has been found to be the average
range of comfort between the counselor and client of both genders (Haase, 1970).
❑❑ The chairs for counselor and the counselee should be placed at right angle as it facilitates the
counselee to look either at the counselor or straight ahead.
❑❑ Place “Do Not Disturb sign’ on the door to prevent others from entering when the counseling is
on progress.
❑❑ Assure auditory and visual privacy to the client as per the professional codes of ethics.
11. ORGANIZATION OF COUNSELING SERVICES

Guidance and counseling has become an integral part of higher education especially nursing educations,
to make it more meaningful and purposeful for the student, although there is no provision of formal
Chapter 14.indd 310 5/18/2012 11:53:45 AM

counseling services for students in nursing schools and colleges. A number of factors are involved for
nonavailability of the professional counseling services that include lack of resources in colleges of
nursing and lack of commitment on the part of administrator and management.
A guidance and counseling committee can be established for the planning and implementation of the
programme under the overall control of principal college of nursing. Lecturer in psychiatric nursing with
certification in guidance and counseling can be appointed as programme coordinator in the initial phase
to chalk out the purposes and framework of the services and identify available resources and physical
facilities for the same. A detailed programme structure can be chalked out as per the institutional needs.
11.1. Programme Structure

11.1.1. Purpose of Organizing Guidance and Counseling Programme
❑❑ To provide a structure to meet the guidance and counseling needs of nursing students.
❑❑ To help students to understand themselves and develop meaningful relationship with others.
❑❑ To help students to plan and achieve educational objectives.
❑❑ To help students to explore personal carrier path in nursing profession.
❑❑ To provide consultation and coordination services to teachers, parents, administrators, and those
who work with students.
❑❑ To ensure availability and accessibility of guidance and counseling to all students.
❑❑ To help students through temporary crisis and refer to those needing special treatment.
11.1.2. Domains of the Programme

The guidance and counseling programme will assist students to acquire knowledge, skills, attitude, and
strategies in the domains that are depicted in Figure 14.7.
Personal
Domains of
Vocational Counselling Social
Programme
Educational
Figure 14.7 Domains of Counselling Programme
Chapter 14.indd 311 5/18/2012 11:53:45 AM

11.1.3. Characteristics of the Programme

❑❑ It is designed and developed as college programme with defined outcome for students from first
year to final year in any nursing course (GNM, B.Sc., and M.Sc. Nursing).
❑❑ It includes achievable and measurable outcomes in all the programme domains: personal, social,
educational, and vocational.
❑❑ Preventive and responsive strategies are included at all the programme domains.
❑❑ The programme is developmental in nature as per the maturity level of the students.
❑❑ A need assessment survey undertaken with students, parents, and teachers delineates the needs
addressed by the programme.
❑❑ Implementation of the programme requires services of a qualified guidance and counselor who
will manage, coordinate, and deliver the services of the programme.
❑❑ It outlines the roles of all faculty members involved in the programme.
❑❑ It includes the setting up of advisory committee which includes the principal, guidance counselor,
nursing faculty, teachers, parents, students, community representatives, and other major stack
holders.
11.1.4. Steps to be taken in Planning and Implementation of the Programme

1. Initiate the programme with established advisory committee.
2. Assess the needs for establishing the programme.
3. Determine the available resources (recruit the guidance counselor if not available).
4. Identify the objectives of the programme in terms of student outcome.
5. Define and clearly delineate the activities of the programme to achieve objectives. Outline the role
of faculty in the implementation of the programme.
6. Implement the programme activities.
7. Evaluate and modify the plan as per requirement.
11.1.5. Advisory Committee for Planning and Coordinating the Programme

Establishment of the advisory committee is an important step toward the organization of the counseling
programme. It is established after the initial meeting with the management in which the concept, need,
and design of the programme is presented. The entire staff of the college is informed and involved in
the initial step of the programme. After the initial approval from the management, advisory committee
is established. It should involve the following members:
1. Administrators
2. Principal
3. Guidance counselor
4. Nursing faculty
5. Students
6. Parents
7. Stakeholders
Chapter 14.indd 312 5/18/2012 11:53:45 AM

The committee is responsible for the need assessment for counseling programme, identify the re-
sources available and arrange for those which are required but not available, defining priorities and
objectives of the programme and defining strategies to implement and evaluate the programme.
11.1.6. Resources Required

Human resources: Professional guidance counselor, office staff, computer operator, and nursing
faculty
Financial resources: Budget, fund raising, grants
Physical facilities: Counseling room, office, etc.
Materials resources: Computer with printer and office stationary
During the planning phase, it should be determined that who is in the best position to deliver
a specific activity of the program (guidance counselor, nursing faculty, parent, or any other
professional).
Programme outcomes are determined according to the selected domains for the programme which
are as follows:
Educational outcome: Students are expected to:
❑❑ Demonstrate knowledge of educational opportunities available to them at each stage of their
professional life.
❑❑ Choose educational options as per his/her personal goals, strength, weakness, and values.
❑❑ Select courses that expand his/her carrier choices in the throat-cutting competition market.
❑❑ Aware about the latest courses in nursing approved by Indian nursing council as well as those
others courses which he/she can pursue as a graduate nurse.
Personal outcomes: Students are expected to acquire the knowledge, skill, and attitude necessary to
understand self.
Social outcome: Students are expected to acquire the knowledge, skill, and attitude necessary to
relate with others in social context.
Vocational outcome: Students are expected to acquire the knowledge, skill, and attitude necessary
to develop life and carrier plans.
12. ROLE OF GUIDANCE COUNSELOR

He/She is a professionally qualified person (master degree in education or psychology with guidance
and counseling specialty or equivalent from a recognized university) who play leadership role in design-
ing, implementing, and evaluating the programme. He/She coordinates all the activities related with the
programme and provides professional guidance and counseling services. His/Her roles can be described
more specifically into the following activities:
❑❑ Establish and coordinate the guidance committee at the college level.
❑❑ Arrange orientation programme for the newly included members of the committee, students, par-
ents, and other supportive staff.
❑❑ Arrange individual or group discussion with students and their parents for providing them
educational and vocational information.
❑❑ Ensure cooperation of all the members of the committee to smoothly run the programme.
Chapter 14.indd 313 5/18/2012 11:53:45 AM

❑❑ Identify and make referral of those cases who require services of clinical psychologist or
psychiatrists.
❑❑ Prepare and administer psychological or counseling test at the local level.
❑❑ Provide professional counseling and guidance services to the students.
❑❑ Conduct research in the area of educational, vocational, personal and social guidance, and
counseling at the local level.
❑❑ Evaluate the effectiveness of the programme in terms of outcomes achieved and communicate the
same to the higher authorities. “Counselors continually assess the needs of their students, evaluate
their programs, and make changes in the school counseling program to better meet the current,
identified needs of students” (Campbell & Dahir, 1997).
❑❑ Arrange special clinics for those students who are in special needs.
❑❑ Organize workshop, seminars for nursing students to explain the principles, techniques, and the
process of the counseling to the bachelors so that they can apply it in practical work setting.
13. TOOLS FOR COUNSELING

The tools for the collection of information during counseling process are divided into two categories:
1. Nontesting tools
2. Psychological test
13.1. Nontesting Tools

These tools are useful for individual assessment without the use of psychological tests. These tools are
generally developed by the counselor and teachers themselves.
❑❑ Interview: It is the heart of the counseling process in which the counselor and counselee
meet face to face and conducts a formal talk with a definite purpose. It serves the purpose
of obtaining and giving information from and to the students as well as sometimes, it may
be a useful tool for need assessment of the guidance and counseling services in a particular
educational institute. It provides opportunity to the counselee to explore his/her conflicts,
problems, and learning difficulties so that the counselor can determine a plan of guidance for
him/her. The counselor can exploit this opportunity to gather background personal informa-
tion about the student. Interview should be well planned in advance to achieve the desired
outcomes.
❑❑ Observation: It provides opportunity to collect data for those areas which cannot be explored in
interview such as attitude, behavior, and physical characteristics. The counselor makes the ob-
servation either by participating observation or by nonparticipative technique of observation.
❑❑ Cumulative record: Cumulative record consists of significant and comprehensive educational
background, attendance, and disciplinary information about the individual student over the period
of years. Besides recording attendance and achievement, it also registers student’s social adjust-
ment in the college and hostel life, his/her behavior with colleagues, and some other qualities like
hardworking, sincerity, outspoken, introvert, and shy. It serves as a rich source of information
about a particular student; hence, it is an important tool to assess guidance and counseling needs
of an individual student.
Chapter 14.indd 314 5/18/2012 11:53:45 AM

❑❑ Anecdotal record: Anecdotal records are verbal snapshots of an incident related to student’s
behavior, usually maintained by the nursing faculty about events which are significant for the
evaluation of the student. Care should be taken to record the incident carefully as it has happened.
A counselor has to maintain the records of anecdotal so that the data can be utilized in counseling
and guidance of a particular student.
❑❑ Personal diary: Provides information about the student’s daily routine, his/her likes and dislikes,
behavior toward others, and personal views toward certain things. Students can be asked to write
daily diary of important events in their day-to-day life.
❑❑ Sociometry: It is a useful tool to explore the kind of relationship a student has with others, his/her
level of social acceptability among colleagues, and social distance among the group of students in
a class. Data obtained by sociometry can be useful to identify difficulties in social adjustment, and
a plan can be made for social guidance and counseling of the particular student.
❑❑ Checklist: It is basically used to identify the expressed problem or interest.
❑❑ Rating scale: It is used to rate certain qualities or characteristics in a student, e.g., punctuality,
honesty, responsibility, attitude, cooperation etc.
❑❑ Health records: Provide information about the health status of a student.
13.2. Psychological Test

Psychological tests are useful tools which provide information about a student’s psychological
characteristics such as personality, IQ (intelligence), aptitude, skills, interest, and special abilities. Some
of the important psychological tests are as follows:
❑❑ Aptitude test: Aptitude is the present qualities of a student which indicates his/her future poten-
tials. Aptitude test it used to estimate the type of field in which an individual can succeed on the
basis of his/her present qualities. For example, engineering and physical science aptitude test,
college aptitude battery tests.
❑❑ Personality tests: Personality refers to what makes an individual different from the others.
Valid and reliable tools to assess the personality of a person are The Rorschach Inkblot Test,
Thematic Apperception Test (TAT), Minnesota Multiphasic Personality Inventory, and Cali-
fornia Psychological Inventory. Information of the personality characteristics may be useful
in social and vocational guidance of a student because certain personality traits may be essen-
tials for a particular type of job, only knowledge and skills are not enough for the successful
work life.
❑❑ Intelligence test: IQ tests are used to assess the level of intelligence in a student, so that the student
can be guided to choose a particular course of study or a particular job. The reliable and valid IQ
tests are Stanford Binet Intelligence scale, Wechsler Intelligence tests, California Test of Mental
Maturity, and Otis Lennon Mental Ability Test.
❑❑ Study habit inventory: It is a useful tool to identify the study habits of a student. Data collected
with the help of study habit inventory may be used to explain learning difficulties of a student so
that appropriate educational guidance can be provided to the student. For example: The Brown
Holtzman Survey of Study Habits is a commonly used tool for this purpose.
❑❑ Interest inventory: It provides information about the interest of a student in a particular field of
study or occupation. For example: Strange Vocational Interest Balnk, Kuder Preference Records
(Figure 14.8).
Chapter 14.indd 315 5/18/2012 11:53:46 AM

Nontesting tools Psychological tests
Interview Attitude test
Observation Personality test
Cumulative
IQ tests
records
Anecdotal Study habit

records inventory
Personal dairy Interest inventory
Sociometry
Checklist
Rating scale
Health record
Figure 14.8 Tools used in the Counseling
14. PROBLEMS IN COUNSELING

❑❑ Lack of knowledge on the part of counselor: Lack of knowledge of the different areas of interest
may pose a difficulty for the counselor. A counselor who is not through with the process, tools
and techniques, and basic communication skills may not serve as an effective counselor. It re-
quires provision of in-service education for the nursing faculty so that they can provide effective
guidance and counseling services for the nursing students.
❑❑ Personal values: It is mandatory for the counselor that he/she should keep on hold his/her per-
sonal values and preferences while providing counseling to the students, but it is quite difficult
Chapter 14.indd 316 5/18/2012 11:53:46 AM

to achieve a satisfactory hold on the personal values for most of the nursing faculties and they
impose the same on the counselee, hence compromising the effectiveness of the counseling.
❑❑ Lack of objectivity: Involvement of the subjectivity in the counseling process by the counselor
reduces its effectiveness.
❑❑ Lack of physical facilities and other resources: Most of the nursing colleges are lacking in separate
physical facilities and provision of professional guidance counselor which leads to disorganized
and ineffective delivery of the counseling services to the students.
15. MANAGING DISCIPLINARY PROBLEMS

Discipline is an area of concern for most of the nursing faculties. Sometimes the faculty complains
“majority of the students were absent in class test,” “most of the students come late in class after lunch,”
“usually students bunks as soon as the teacher leaves the clinical area,” and “students were busy in gos-
siping and sleeping while the class was on.” These are the snapshots of situations which reflect that there
are disciplinary problems among the students which must be managed to achieve overall curriculum ob-
jectives as well as to maintain conducive teaching learning environment in a college or school of nursing.
Managing disciplinary problems is quite difficult if disciplinary plan is not well conceived in advance and
not implemented consistently throughout the academic year. Disciplinary problems is just not the matter of
classroom setting, but it should be viewed comprehensively including the various settings where students
are involved such as clinical area, hostels, laboratories, library, community area, and so on.
15.1. Disciplinary Problems

❑❑ Absenteeism
❑❑ Coming late to clinical area and leaving early
❑❑ Late submission of assignments
❑❑ Arrogant behavior toward the colleagues and teachers
❑❑ Gossiping, sleeping in the classroom
❑❑ Showing lack of attention and disinterest in teaching–learning activities
❑❑ Confrontation with the teachers
❑❑ Violating general rules and regulation of the institutions
❑❑ Cheating in class tests
❑❑ Making noise in library
❑❑ Disturbing other students on the floor in hostel during study time
For managing disciplinary problems, it is essential for the teacher to know about the individual student
because some disciplinary problems may be the manifestation of the physical illness which has to be
handled with different approach as compared to other problems which are more or less the student’s ten-
dency to behave in that particular way. The management of disciplinary problems can be divided into two
parts: preventive discipline management and corrective or supportive discipline management.
15.2. Preventive Discipline Management Strategies

❑❑ Clearly communicate the expectations and needs to the students: Teacher and students should clearly
communicate reciprocally their expectations and needs about the discipline to each other on the very
Chapter 14.indd 317 5/18/2012 11:53:46 AM

first day of class or clinical or community area. For example, students’ needs may include requirement
for favorable teaching learning environment, right to learn without any disturbance caused by others;
similarly, teacher may expect the students to establish good teaching–learning environment and no
disruptive behavior in classroom, clinical area, or any other teaching–learning setting.
❑❑ Creation of warm nurturing environment in the campus: The teaching–learning environment
should be clean, well arranged with aesthetic look, and should be free from distracters. Classroom
should be systematically arranged allowing the teacher to move freely and enabling the students
to watch blackboard or any other media used by the teacher without any difficulty. The teacher
should treat the students with dignity and due respect and they should be given individualized
attention by the teacher within and outside the classroom. Similarly, students should be expected
to respect the teacher in all the teaching–learning and outside settings.
❑❑ Develop and review periodically the rules and consequences with the participation of the stu-
dents: Classrooms rules, clinical area rules, community area rules, library rules, and hostel rules
should be developed democratically with the involvement of the students. Rules should be stated
in behavioral terms and should not be excessive in numbers, as nobody can remember all the rules
if the list of rules is too long. Consequences of breaking the particular rule or showing disruptive
behavior should be presented logically and clearly. All the rules and consequences should be dis-
played on the classroom, library, clinical area, hostel, and community area notice boards as well
as bulletin boards.
❑❑ Overplan the teaching–learning activities for the classroom lessons, clinical, and community area
so that there will no free time available for the students during which most of the disruptive
behavior is shown by the students.
❑❑ Make learning activities attractive, interesting, innovative, and enjoyable: Make your classroom
lessons more interesting with the use of innovative teaching–learning strategies which is helpful
to prevent boredom of routine classroom and leads to active learning among students as well as
prevent disruptive behavior.
❑❑ Identify the guidance and counseling need of a particular student proactively and refer the student
to guidance counselor.
15.3. Supportive and Corrective Discipline Management Strategies

Deal with disruptive behavior immediately and show consistency in your dealings. Apply hot stove
rules (McGregor 1967) in dealing with disciplinary problems shown by the students. Hot stove (disci-
pline administrator) burns your hand (consequence) immediately as soon as you put your hand over it
(break of rule). As a teacher show consistency in your approach of discipline administration, if you are
not consistent in discipline administration students will not take you seriously and will be more prone
to show disruptive behavior. The consequences of continuous misbehavior shown by the student should
be progressively increased in intensity, leading to suspension or rustication of the student from the col-
lege. Avoid any power struggle with the student and prevent escalation of the situation by talking to the
student at every aspect of disciplinary actions.
Behavior modification strategies can be employed to modify or correct the problem behavior of
the student using the principles of classical conditioning or operant conditioning (positive or negative
reinforcement) theory.
Arrange a disciplinary conference for the problem student with the head of the department if required.
Administer discipline in progressive steps (except for more serious case) which include oral warning,
written warning, suspension, and termination.
Chapter 14.indd 318 5/18/2012 11:53:46 AM

Hot Stove Rules

❑❑ All the students must be aware of rules and consequences beforehand (if you touch the hot stove
you will be burned, so rule is that you should not touch the hot stove)
❑❑ Administer discipline immediately after the rule is broken (you will be burned immediately as
soon as you touched the stove)
❑❑ Maintain consistency in discipline administration; each time the rule is broken there is imme-
diate and consistent consequence for the same (every time you touch the hot stove you will be
definitely burned)
❑❑ Every student should be treated impartially in the same manner when the rule is broken (if another
person touches the stove he/she will receive the same punishment that is the burning of the hand)
16. MANAGEMENT OF CRISIS AND REFERRAL

Meaning of Crisis
A crisis is an overwhelming reaction to a threatening situation in which a person’s usual problem-
solving strategies fail to resolve the situation resulting in a state of disequilibrium. It is a sudden, gener-
ally unanticipated event that profoundly and negatively affects a significant segment of the institution
population and often involves serious injury or death.
Crisis management is the plan of activities to respond to a major threat to a person, group, or organization.
Most people live whether physically, intellectually, or morally in very restrictive circle of their
potential being. They make use of very small portion of their soul’s resources---Great emergencies
…Crisis shows us how much greater our vital resources really are... Than we supposed
—Williams James
Crisis management typically includes identifying the real nature of a crisis, intervening to minimize
damage, and recovering from the crisis. It should be a central component of a comprehensive college or
school safety program. The primary objectives of crisis management are to promote the health, safety,
and welfare of students, staff, and visitors; protect school property; and regulate the operation of college
during an emergency. The college-based crisis management team (CMT) is critical to the successful
management of college or schools catastrophes. Examples of such incidents which are usually referred
as crisis in an educational institute are as follows:
❑❑ Suicide of a student
❑❑ Serious injury or death of a student
❑❑ Catastrophic events/natural disasters
❑❑ Sexual assaults
❑❑ Rape
❑❑ Terrorism
❑❑ College bus accident
❑❑ Picnic catastrophes
❑❑ Demonstration
❑❑ Kidnapping or abducted students
❑❑ Weapon violation
❑❑ Fire/explosion
Chapter 14.indd 319 5/18/2012 11:53:46 AM

Situations can range from a nonemergency school crisis involving a single student to a life-threaten-
ing situation affecting the entire school students. Incidents and emergencies can occur before, during, or
after school hours, on or off school property.
“When the load shifts or gets too heavy, we may slip or stumble off the path of life, sometimes
we need help getting back on our path and continuing our journey.”
—Unknown
Crisis management plans are intended to guide staff in responding to crisis such as death of the stu-
dent or teacher or other traumatic events that can affect college community for days. These procedures
are intended to be time limited, problem focused, and intervention designed to identify and resolve the
crisis, restore equilibrium, and support protective responses.
16.1. Crisis Management Plan

Crisis management team (CMT) under leadership of the principal college of nursing should be estab-
lished to develop a crisis management plan and protocols. The CMT is responsible for dealing with cri-
sis and critical incidents in a college of nursing, providing information to students, staff, and community
on crisis management procedures and protocols, providing assistance during a crisis, and conducting
debriefing at the conclusion of each crisis episode. The plan of crisis management is reviewed and up-
dated periodically in the meetings of the CMT which should be held time to time under the leadership of
the principal. The CMT of college of nursing should look into the following area of crisis management:
❑❑ Establishment and institutionalization of an incident command system under the control of
commanding officer.
❑❑ Identification and listing of CMT members with their mobile numbers and their respective roles
in managing crisis incidents.
❑❑ Identification of on-site and off-site command posts, media staging areas, parent reunion areas,
and evacuation areas in the event of crisis.
❑❑ Standardization of school-based emergency response and protective procedures for evacuations,
lock downs, and secure the building of college.
❑❑ Drill, exercise and training schedules, requirements, and documentation procedures.
❑❑ Detailed floor plans, site maps, and exterior door numbering system have to be planned.
❑❑ Identification of communications protocol to warn and communicate with occupants (terrorist) in
school buildings, the community, and local response agencies during an emergency. Typical meth-
ods of communication are bell and fire alarm systems, telephone, cell phone, and intercom system.
❑❑ Locations of automated external defibrillators (AEDs).
❑❑ Identification of college-based faculty professionally trained and certified in basic life support
techniques, CPR, and AED to render emergency medical aid.
❑❑ Conduct debriefing to help analyze how school personnel and first responders function during an
exercise or actual emergency.
Crisis or emergency planning focuses on the four phases of emergency management:
1. Mitigation/prevention
2. Preparedness
3. Response
4. Recovery
Chapter 14.indd 320 5/18/2012 11:53:46 AM

Mitigation and Prevention

Mitigation is any sustained activity that college takes to reduce the loss of life and damage related to
events that cannot be prevented. These activities may occur before, during, or after an incident. Preven-
tion is any step that schools can take to decrease the likelihood that a crisis incident will occur.
Risk or hazards assessment: A college-centered crisis management program examines potential
emergencies and disasters based on the risk posed by likely hazards, develops and implements pro-
grams and actions aimed toward reducing the impact of these events on the individual school, prepares
for those risks that cannot be eliminated, prescribes the actions required to deal with the consequences
of the events and takes action to quickly recover from the event.
Risk or hazards can be classified into three categories: natural, technological, and college-specific
hazards.
Preparedness
The preparedness phase readies schools to respond in a rapid, coordinated, and effective manner to a
crisis because it is not possible to completely mitigate every hazard that poses a risk; preparedness mea-
sures can help to reduce the impact of the remaining hazards by taking specific actions before a crisis/
emergency event occurs.
Training for Preparedness
Conducting critical incident drills and emergency exercises involving the CMT, teachers, support staff,
custodial, transportation, and students are essential for the successful implementation of crisis plans.
They offer opportunities for everyone to evaluate what works, what needs to be improved, and how well
students and staff respond and cooperate during the drills and emergencies.
Command Post
Command posts are locations which serve as an assembly point for the CMT and the initial emergency
responders to perform on-scene incident command functions. The incident supervisor is responsible for
establishing and staffing the CMT command post.
Media Staging Area
The media staging area can be any location in which media representatives and their equipment can be
temporarily housed or parked while awaiting news releases and briefings.
Communications
The delivery of timely and accurate information before, during, and after an incident is a critical compo-
nent of crisis and emergency management. Ensuring that students, faculty and staff members, parents,
local response agencies, the media, and the community have information is the joint responsibility of
the crisis team members.
Response
When crisis or emergencies arise, schools must quickly implement the policies and procedures devel-
oped in the prevention–mitigation and preparedness phases to effectively manage the crisis and protect
the school community.
Examples of response activities include:
❑❑ Activating the CMT
❑❑ Delegating responsibilities and establishing an incident command post
❑❑ Deploying resources, activating the communication, and primary response procedures
❑❑ Documenting all actions, decisions, and events, e.g., what happened, what worked, and what did
not work
Chapter 14.indd 321 5/18/2012 11:53:46 AM

Important Responses During a Crisis or Emergency

❑❑ Lockdown is used to describe enhanced security measures taken to protect against potentially violent
intruders that may be inside the building or on the school site. The response secures students and
staff, usually in classrooms, to prevent access or harm to the occupants of the lockdown locations.
❑❑ Shelter-in-place procedures are used to temporarily separate people from a hazardous outdoor
atmosphere, such as in chemical, biological, or radiological agent releases.
❑❑ Evacuation is used when locations outside of the school building are safer than inside the school.
It involves the controlled movement of students from the building to a prespecified safe location.
Evacuation routes should be specified according to the type of emergency and location of incident.
Recovery
The recovery phase is designed to assist students, staff, and their families in the healing process and to re-
store educational operations in schools. Recovery is an ongoing process that includes not only the mental,
emotional, and physical healing process of students, faculty, and staff, but also a school’s physical (build-
ings and grounds), fiscal (daily business operations), and academic (a return to classroom learning) recu-
peration. Strong partnerships with public safety and mental health communities are essential for effective
recovery efforts. The type and extent of activities will vary in relation to the size and scope of the crisis.
There are three components of recovery:
❑❑ Physical/structural
❑❑ Restoration of academic learning
❑❑ Psychological/emotional
Example of Crisis Management in Special Cases
Crisis Due to Kidnapping of Student

Role of Teachers/Staff/Principal/CMT
❑❑ Verify that a student has been abducted
❑❑ Ensure the principal, CMT and all school personnel are aware of the abduction
❑❑ CALL 100, the police department
❑❑ Contact parent or guardian and report the abduction
❑❑ Activate the CMT and decide what additional resources and support will be needed
❑❑ Gather information about the abduction, description of the perpetrator, and any vehicle
involved
❑❑ Obtain information on possible witnesses, friends, and the last person to see the student
❑❑ Notify appropriate assistant superintendent, Office of Safety & Security, and all concerned
departments
❑❑ Check abducted student’s file for any restraining orders or other background information
❑❑ Provide police with physical description of the student: Sex, height, weight, skin colour,
eye colour, clothing, backpack, and student photograph, if available, victim’s home address,
phone number, parents’ contact information
❑❑ Refer all media inquiries to police media representative
❑❑ Document all actions taken
Chapter 14.indd 322 5/18/2012 11:53:46 AM

Crisis Due to Missing Student

Role of Principal/Crisis Management Team Leader
❑❑ Contact parents/guardians to report absence or missing or kidnapping of the student
❑❑ Call police department for assistance
❑❑ Provide CMT and school personnel with the description of missing student
❑❑ Assign CMT members to organize search
❑❑ If event is happening during the school day, consider holding the bells until the student is
located or the school has been completely searched
❑❑ Notify to appropriate assistant superintendent and the Office of Safety & Security
❑❑ Interview friend(s) of missing student and the last person to see the student
❑❑ If incident occurred while student was on the way to or from school, contact bus driver, cross-
ing guard, or safety patrol, if applicable
❑❑ Document all actions taken
Role of Teachers/Staff
❑❑ Verify the student is missing
❑❑ Notify the principal and the main office
❑❑ Provide a physical description of the student, if needed
❑❑ Assist with any search of the school building and grounds
❑❑ If the student is located, notify the principal and main office
Crisis Due to Sexual Assault

Sexual assault is a crime of violence. For the victim, it is often an experience of fear, loss of
control, humiliation, and violence. Victims may experience a full range of emotional reactions.
Role of Principal/Crisis Management Team
❑❑ Call 100 and request that police respond; also if immediate medical attention is needed re-
quest emergency medical personnel
❑❑ If there is a crime scene related to the assault, isolate the area and assign a staff member to
safeguard it
❑❑ Isolate the victim from the crime scene, suspect(s), and witnesses
❑❑ The victim should not be questioned beyond obtaining a description of the perpetrator
❑❑ The victim should not eat or drink, change clothes, or shower, while awaiting police arrival
❑❑ Notify appropriate assistant superintendent and the Office of Safety & Security
❑❑ Confidentiality must be maintained during the investigation
❑❑ Direct the individual (student or staff) not to repeat any information elsewhere in the school
❑❑ Take action to control rumours
❑❑ Document all actions taken by staff
Chapter 14.indd 323 5/18/2012 11:53:46 AM

Role of Teachers and Staff

❑❑ Notify the principal immediately
❑❑ DO NOT LEAVE THE VICTIM ALONE
❑❑ Determine if immediate medical attention is needed, if so summon help
❑❑ Isolate the victim from the crime scene, suspect(s), and witnesses
❑❑ The victim should not be questioned beyond obtaining a description of the perpetrator
❑❑ If appropriate, preserve all physical evidence of the crime
Crisis Control Emergency Kit

The following items shall be maintained in the designated school crisis control centre and carried to any
alternate site as per requirement:
1. Keys to all doors in the school facility
2. Floor plan that shows the location of all exits, telephone wall jacks, computer location, and other
devices that may be useful in communication during crisis.
3. Blueprints of school building
4. Phone numbers of important personnel and all emergency numbers such as:
❑❑ Police department
❑❑ Rescue/ambulance
❑❑ Fire department
❑❑ Poison control centre
❑❑ Local affiliated hospital
5. Students’ list including home address and phone numbers
6. First-aid kit
Referral Services
Since some problems and concerns are beyond the capability of the school counselor or guidance teach-
er, it is important to establish a referral network. This should consist of a team of well-trained and
skilled professionals who have expertise in assisting referred individuals. Referral does not imply the
helper might have failed, but signifies strength on the part of the helper, who recognizes his/her limita-
tions, and explores opportunities to maximize the help he/she can offer. A programme leader should,
therefore, be well informed about referral services, which include social workers, doctors, psychiatrists,
psychologists, priests, police, and others.
Chapter 14.indd 324 5/18/2012 11:53:46 AM

CHAPTER HIGHLIGHTS
❑❑ Guidance is that aspect of the educational programme which is concerned especially with help-
ing the pupil to become adjusted in his/her present situation and to plan their future as per his/her
interest, abilities, and social needs.
❑❑ Counseling is a process through which one person helps another by purposeful conversation in an
understanding atmosphere. It seeks to establish a helping relationship in which the one counseled
can express their thoughts and feelings in such a way as to clarify their own situation, come to
terms with some new experience, see their difficulty more objectively, and so face their prob-
lem with less anxiety and tension. Its basic purpose is to assist the individual to make their own
decision from among the choices available to them.
❑❑ Counseling involves relationship between two persons, one who is overwhelmed with problem
is at one end (counselee) and the other who assists the person to overcome the problem is a
counselor at other end.
❑❑ Changing conditions of home, technological explosion, changing moral and religious condi-
tions of the society, and appeals of pseudosciences are some factors that give rise to the need of
counseling.
❑❑ Long-duty hours, complex hostel life, night duty, dealing with life-and-death situation, and getting
experience not fit for the age are some of the factors which requires the availability of the counseling
services in college of nursing.
❑❑ Guidance is a term which is broader than counseling and it includes counseling as one of its con-
cept. Counseling is a part of guidance, not all of it.
❑❑ Counseling is based on the principles of human dignity, holding personal values, confidentiality,
privacy, and voluntary process.
❑❑ Steps of counseling process usually includes establishing trustworthy relationship, assessment,
setting goals, intervention and termination, and follow-up.
❑❑ Directive counseling or counselor-centered or clinical counseling: This approach of counseling
assumes that the counselor is more competent than the counselee, and counseling is primarily an in-
tellectual rather than emotional process; hence counselor should play active role to direct the process.
❑❑ Nondirective counseling approach: The role of the counselor is relatively passive, and the client
has to take the responsibility of exploring his/her problem situation, the counselor is neither agree
nor disagree with the client but shows friendliness, and receptive attitude.
❑❑ Eclectic approach is the combination of the directive and nondirective approach of the counseling
based on Thorne’s orientation to the theory and practice of personality counseling that emphasize
that counselor should be competent to use all available methods or resources.
❑❑ The guidance and counseling programme will assist students to acquire knowledge, skills, atti-
tude, and strategies in the following programme domains:
1. Personal domain
2. Social domain
3. Educational domain
4. Vocational domain
❑❑ Interview, cumulative record, anecdotal record, and personal diary are some of the tools of
counseling.
Chapter 14.indd 325 5/18/2012 11:53:46 AM

❑❑ Standardized tools of counseling includes personality test, aptitude tests, intelligence tests, study
habit inventory, and interest inventory.
❑❑ Crisis management typically includes identifying the real nature of a current crisis, intervening to
minimize damage, and recovering from the crisis.
❑❑ The primary objectives of crisis management are to promote the health, safety, and welfare of
students, staff, and visitors; protect school property; and regulate the operation of college during
an emergency. The college-based CMT is critical to the successful management of college or
schools catastrophes.
EVALUATE YOURSELF
Q 1: Define counseling? What are the purposes of counseling? Explain the basic principles of coun-
seling (RGUHS, 2010).
Q 2: Write a short note on counseling (NTRUHS, 2009).
Q 3: Explain in detail how you will organize counseling services in a nursing educational institution
(RGUHS, 2009).
Q 4: Explain the need and significance of counseling services in a school of nursing?
Q 5: What are the types of counseling approaches? (RUHS, NIMS, 2008; RGUHS, 2010)?
Q 6: List the differences between counseling and guidance.
Q 7: Explain the various techniques of counseling.
Q 8: What are the steps in counseling process? Explain in detail.
Q 9: What are the issues in counseling of nursing students?
Q 10: Write short notes on:
❑❑ Crisis management plan in nursing institution
❑❑ Managing disciplinary problems
❑❑ Preventive discipline
❑❑ Hot stove rules of discipline
1. Townsend Mary C. (1999). “Essentials of psychiatric mental health nursing”, Philadelphia: FA
Davis Company. pp. 111–116.
2. Porter T., Grady O. (1994). “The nurse manager’s problem solver”, Philadelphia: Mosby.
pp. 121–122, 211–212.
3. Gibson R.L., Mitchell M.H. (2003). “Introduction to counselling and guidance”, 6th edition, New
Delhi: Prentice-Hall of India Pvt. Ltd.p. 290.
4. Bhatia K.K. (2002). “Principles of guidance and counseling”, Ludhiana: Kalyani Publishers.
pp. 75–197.
5. Cormier L.S., Hackney H. (1987). “The professional counsellor: A process guide to helping”, New
Delhi: Prentice-Hall Inc. Englewood Cliffs.
6. http://www.basic-conselling-skills.com
Chapter 14.indd 326 5/18/2012 11:53:46 AM

7. Menon S. Workshop for senior administrators. NIHFW.

8. Human relations. Workshop.
9. Kochhar S.K. (1984). “Guidance and counselling in colleges and universities”, Sterling Publishers
Private Ltd. pp. 161–196.
10. Sharma Ramnath. (2002). “Guidance and counseling”, 3rd reprint, Subject Publications. pp. 268–288.
11. Jones Arthur J. (1951). “Principles of guidance”, 5th edition, McGraw Hill Book Company, Inc.
pp. 209–214.
12. Anand S.P. (2005). “ABC’s of guidance in education”, 5th edition, Mrhamaya Publication House.
pp. 94–104.
13. Lalitha K. (2007). “Mental health and psychiatric nursing. An Indian Perspective”, 1st edition,
VMG Book House. pp. 144–151.
14. Barton L. (2007). “Crisis leadership now: A real-world guide to preparing for threats, disaster,
sabotage, and scandal”, New York, NY: McGraw-Hill.
15. Edward P. Borodzicz. (2005). “Risk, crisis and security management”, West Sussex, England: John
Wiley and Sons Ltd.
16. Coombs W.T. (2006). “Code red in the boardroom: crisis management as organizational DNA”,
Westport, CT: Praeger.
17. Office of Security and Risk Management Services (October 2007). ““Crisis Management Work-
book”, Fairfax County Public Schools. Retrieved from http://www.fcps.edu/fts/safety-security/
publications/cmw.pdf.
18. Davidson M.N. (2005). Ethics in human resource management. In P.H. Werhane, R. E. Freeman
(Eds.), “Blackwell Encyclopedic Dictionary of Business Ethics”, Malden, MA: Blackwell
Publishing.
Chapter 14.indd 327 5/18/2012 11:53:46 AM

c h a p t e r 15
In-Service Education
1. INTRODUCTION
In-service education is a type of education that is provided to the employees while they are on the job so
as to improve their working capacity and efficiency. The concept of in-service education is in budding
form in India, whereas in western countries it has grown fully and has become an essential requirement
of professional growth of a nurse.
2. NATURE AND SCOPE OF IN-SERVICE EDUCATION

Health care industry is complex and ever changing; therefore, nurses need to be professionally competent
in order to survive in this era of increasing law suits against health care professionals as well as in-
creasing health care cost. Research has exploded the knowledge horizon of the nursing sciences, and
a graduate has to update himself/herself continuously to maintain the competency and keep pace with
the changing concepts of delivery of nursing services to the patient. A graduate nurse who is competent
today may not be considered competent 5 years later if he/she has not updated himself/herself with the
changing knowledge or skills. For example, if somebody has studied cardiopulmonary resuscitation
(CPR) in the year 2005 and has not updated his/her knowledge, he/she will be considered incompetent
and knowledge outdated as the American Heart Association guidelines for CPR has been changed in the
year 2010. Hence, maintaining competency is something which is very much important for health care
professionals so that public can be assured that their health care is in safe and competent hands. Four
avenues have been identified as the primary means for examining competence of nurses. They are peer
review, practice audits, re-examination, and continuing education.
Re-examination is an important mechanism to maintain the competency of nurses which has been
debated in many professional circles in India. It is still an issue under consideration whether re-exami-
nation should be conducted periodically or at the time of renewal of license for all the nurses. In-service
education is another area of concern which has gain popularity in corporate sector of health care to
maintain competency of the nurses.
Staff development, continuing education, and in-service education are three different interrelated
concepts which are frequently used in the job settings of the health care professionals. Let us discuss the
meaning and definition of these terms.
3. CONCEPT OF STAFF DEVELOPMENT

Staff development refers to both formal and informal learning activities that relates to the employee’s
role expectations and takes place either within or outside the health care agency. It simply refers to
Chapter 15.indd 328 5/18/2012 11:59:31 AM

In-Service Education | 329
any efforts to improve the knowledge, skills, and attitude of an employee so that he/she can serve with
his/her maximum potentials to the health care agency. It is the process of enhancing staff performance
with specific learning activities.
The concept of staff development came into existence in the 1930s during the period of recession when
large numbers of nurses moved from individual practices to hospital services. This resulted in the first or-
ganized approach to staff development. During this time, staff development activities included orientation
and skill training; thereafter, gradually nurses became more concerned with self-evaluation. Another factor
which affected staff development came into existence during 1960s as a result of impetus in research. In the
1970s, new concerns for nursing and consequently a new emphasis on staff development have emerged.
According to American Nurses’ Association, there are three components of staff development which
includes orientation, in-service education, and continuing education.
The door to development is locked from the inside. No one can develop anyone except himself.
—C. Argyris
3.1. Orientation
Orientation is the process of making aware the new employee about the policies, procedures, purposes,
and position requirements in the health care organization. It is also useful for a present employee when
he/she is put into a new role or job position. Specific contents of orientation program may include intro-
duction to the existing employees, supervisors, history, philosophy and goals of agency and department,
job descriptions and role expectations, nursing care standards, patient safety protocols, physical set-up
and facilities, records and reports, and procedures and performance appraisal.
Continuing
Education
Staff
Development
Orientation In-Service
Education
Figure 15.1 Components of Staff Development
Chapter 15.indd 329 5/18/2012 11:59:32 AM

3.2. In-Service Education

The word “in-service” implies that learning occurs within the service organization. It is that part of
continued learning that the agency offers to increase the employees’ skills, knowledge, and attitude in
relation to specific aspects of the role expectations. In other words, it is a program of training that is
provided by an organization for its employees within the organization to increase the knowledge skills
and competence of the employees in a specific area of work. It also includes those efforts that precede
any change in policy and procedures of an organization so that all the staff members can play effective
role in implementation of the newly introduced change and can perform better as per the newly intro-
duced policies and procedures. In-service education may or may not be a planned event or activity.
Sometimes, it is equated with the incidental learning, for instance, a doctor–nurse conference related
to a patient care may serve the purpose of in-service education. During this interaction, the nurse may
come to know about new research data or new therapeutic interventions, new drugs, and so on, which
will improve the knowledge, skill, and attitude of the nurse. There are plenty of opportunities for in-
service education or incidental teaching in clinical area, but he/she has to keep her eyes and ear open
with mental alertness to learn from each incident, which happens in day-to-day practice of nursing.
Similarly, it may be planned activity to improve the knowledge and skills of nurses in a particular area
that is related with their job.
Examples of in-service education include equipment demonstrations, nursing care conferences,
self-instructional packages, and cardiac catheterization.
Let us never consider ourselves as finished nurses

—Florence Nightingale
From the above discussion of the in-service education, it is clear that it is not intended to provide new
knowledge or skills to the employees but it improves their knowledge and skills in those areas which are
directly related with the job performance.
3.3. Continuing Education

Continuing education is another concept within staff development, which refers to the provision for
employees to learn new knowledge and skills, review and add to knowledge already gained, inves-
tigate new approaches in nursing practice, analyze and redevelop attitudes, and strengthen clinical
competencies. It includes all systematically organized, planned efforts that are designed to maintain and
improve the abilities of employees. It may also include an organized planned program or an independent
endeavor on the part of the learner. Continuing education offerings are formal in nature and generally
offered as workshops, seminars, courses, or conferences.
4. NEED FOR IN-SERVICE EDUCATION

We live in a period of knowledge explosion with rapidly changing health care technology. New
research findings, emphasis on evidence-based practice, and use of complex technology necessities for
in-service education or staff development so that the staff can perform better with the latest knowledge
and skills.
Chapter 15.indd 330 5/18/2012 11:59:32 AM

Educational preparation of the nurses varies (ANM, GNM, B.Sc. Nursing), which depends on
the quality of facilities in the educational institutions, and some students may not have developed
all of the skills and knowledge necessary to perform at the expected level, thus requiring in-service
education.
The success of a health care organization depends on the educational level and competency of the
personnel; therefore, properly educating employees’ results in higher productivity, fewer mistakes, and
better nursing care.
In this era of cost containment, organizations cannot afford the cost caused by negligence and
malpractice of the incompetent nurses. Increased public awareness, quality assurance demands efficient
and competent nurses to fulfill the patient expectations.
Therefore, in-service education is very important for the success of health care organization
because even if fully qualified, competent staffs are available time gradually erodes that competence
as conditions change and old competencies become obsolete. The gap between what people can do
and what they are potentially capable of doing is also enormous for most staff nurses. In-service
education is the vehicle for providing such “updating” to mature, tenured people (Harris, 1989;
Ryan, 1987).
5. CHARACTERISTICS OF IN-SERVICE EDUCATION

❑❑ It improves the performance of the employees and meets organizational goals.
❑❑ All staff, as life-long learners, shares a personal responsibility for individual and organizational
growth through in-service education.
❑❑ Training is planned, systematic, and sustained or sometimes it may be incidental.
❑❑ Internal resources are valued and use effectively for arranging training program.
❑❑ Collaboration and trust are essential for the success of the program.
❑❑ Programs include rigorous evaluation and communication of results to all concerned.
6. PRINCIPLES OF ADULT LEARNING

Principles of adult learning are important for the successful deployment of the in-service education
program. Adult learning theory was proposed by Knowles, which emphasizes that children and adults
learn differently. Malcolm Knowles suggested that there are basic conceptual differences between
adult and child education. Malcolm Knowles first used the term “andragogy” to describe adult learn-
ing which relates to the “The art and science of helping adults learn” (Knowles 1970). On the con-
trary, pedagogy is generally used to describe the “the science of teaching children.” Knowles clearly
theorized how adults learn and described adult learning as a process of self-directed inquiry. Knowles
argued that:
❑❑ Adults have a need to know why they should learn something. They have to consider it important
to acquire the new skill knowledge or attitude.
❑❑ Adults are self-directed and can decide what they want to learn.
❑❑ Adults have a far greater volume and different quality of experiences than young people; therefore,
connecting learning experiences to past experience can make the learning more meaningful and
assist them to acquire new knowledge.
❑❑ Adults become ready to learn when they experience a life situation where they need to know.
Chapter 15.indd 331 5/18/2012 11:59:32 AM

❑❑ Adults enter into the learning process with a task-centered orientation to learning.
❑❑ Adults are motivated to learn by both extrinsic and intrinsic motivation.
❑❑ Adults prefer learning situations that show respect for the individual learner and so provide for
their physical needs through breaks, snacks, coffee, and a well organized, differentiated experience
that uses time effectively and efficiently.
❑❑ Adults prefer learning situations that are practical and problem centered; therefore, the teacher
should use collaborative and authentic problem-solving activities.
According to Carl Rogers, another educational pioneer argued that the adult learning process is
facilitated when:
❑❑ Significant learning takes place when the subject matter is relevant to the personal interests of the
student.
❑❑ The student participates completely in the learning process and has control over its nature and
direction of the learning.
❑❑ It is primarily based upon direct confrontation with practical, social, personal, or research
problems, and
❑❑ Self-evaluation is the principal method of assessing progress or success of the teaching–learning
activities.
7. AREAS OF IN-SERVICE EDUCATION

As mentioned previously, in-service education can be provided anywhere, anytime in the settings of
the job on any topic that is deemed necessary to teach an employee. Broadly, the areas of in-service
education can be categorized as follows:
❑❑ Skill training
❑❑ Administrator role
❑❑ Leadership training
❑❑ Counseling
8. SYSTEM APPROACH TO IN-SERVICE EDUCATION PROCESS

System approach to in-service education involves three steps which are input, process, and output.
Input
Input factors are divided into three main segments that include organizational, health care, and individual
factors. These factors define certain parameters for the agency and give direction to the in-service
education process.
Process
Within the context of the climate and planning mechanism, the next step “process” commences. Climate
setting for in-service education must be an energetic and cognizant effort in order to influence the
overall process of in-service education. While planning in-service education program, one must con-
sider the learning climate within the agency in order to identify the needs for in-service education and
design a plan to meet these needs. During implementation, climate setting is once again emphasized in
order to establish the most conductive atmosphere for learning. Identification of needs is based on the
Chapter 15.indd 332 5/18/2012 11:59:32 AM

inputs from the employees, and once particular needs are identified they are translated into general and
specific objectives. These objectives in turn establish an evaluation mechanism and guide the develop-
ment of learning experiences for in-service education. The plan of learning experiences describes how
the learning objectives will be attained.
Output
It is demonstrated in performance behaviors of in-service participants which identify the success or
failure of the in-service education effort. Purpose of in-service education is change; so, if no change is
seen then the output is not what was expected and there may have been an error made in determining
input or in using the process for in-service education.
9. ORGANIZING IN-SERVICE EDUCATION PROGRAM

There are numerous models and plans for in-service education in the literature. Some of these are rather
simple and others are highly abstract and theoretical. The model based on systems approach to in-
service education suggests five stages to in-service education which are as follows:
Stage 1: Analysis of the Learning Needs of the Employees/Need Assessment
First step in organizing in-service education is needs assessment for an in-service educational program.
Systematic determination of educational needs based on organizational goals is important for developing
specific learning experiences for in-service education. Training is not developed in a vacuum; training pro-
grams are developed to meet needs, and needs should be arrived at systematically by identifying discrepan-
cies between current and desired conditions. Thus, when in-service training programs are being designed,
need analysis becomes the first step to gather information about discrepancies and to use that information
to make decisions about priorities and goals of in-service education. Training needs are often derived from
a job analysis or from a comparison of the present performance of personnel with the desired performance.
In conclusion, this stage includes:
❑❑ Analysis of the needs, goals, and priorities
❑❑ Analysis of the resources, constraints, and alternate delivery systems
❑❑ Determining scope and sequence of training program by performing task and job analysis
There are many ways to collect information about needs, some of which are as follows:
❑❑ Consultation with advisory groups
❑❑ Analysis of quality improvement data
❑❑ Professional standards of practice
❑❑ Observation of personnel performance in job settings
❑❑ Verbal and written communication: survey questionnaire, skill inventories, pre- and posttests, and
performance appraisal
❑❑ Analysis of records and reports: nursing audits, incidental reports, patient questionnaire, turnover
and absentee records, statistical records, employment application, annual reports.
❑❑ Changes within and outside the organization
Stage 2: Plan and Design the In-Service Education Program

In this stage, the program coordinator or managers make a decision about the overall plan and design of
the program. They have to:
Chapter 15.indd 333 5/18/2012 11:59:32 AM

❑❑ Determine training approach (workshop, conference, self-instructional module, etc.)

❑❑ Identify and develop learning objectives that are specific and measurable
❑❑ Develop performance measures
❑❑ Develop training program specifications (time, venue, program schedule, etc.). The strategy used
for training program should be based on the assessed learning needs, the employees, and the
available organizational resources.
Determine training approach: Some skills are best taught in the classroom; some in the laboratory
and some through simulation. Therefore, the program coordinator has to decide about the training
approach that will be suitable for specific learning objectives and available resources. The nature of the
task to be learned will suggest the setting in which it should be taught and evaluated. Plans are made for
various sized group activities and the needed teacher guides are noted.
Development of learning objectives: Learning objectives should be based on the results of the
task analysis and should be stated in behavioral terms to ensure that the results of training are
measurable.
Develop performance measures: Using the clues provided by the action words in the specific
learning objectives (e.g., list, explain, demonstrate, and classify), the appropriate test items should be
developed for evaluation. For example, in order to measure a trainee’s ability to recall information, a
completion item would be most appropriate. Once developed, test items are used to form pretests and
posttests.
Develop program specification: The program coordinator has to determine about the time, venue,
topics, and teaching learning strategies for each topic and program schedule based on the available
data.
Stage 3: Development of Resource Materials and Media

It includes:
❑❑ Development of the curriculum guide for the program: the overall curriculum is outlined and the
foundation for the construction of the training program is developed
❑❑ Development of lesson plans
❑❑ Development of various educational media for the training program
The analysis and design phases provides information about what will be taught, what tasks trainees
need to learn to perform, and what learning elements (knowledge, skill, and attitudes) are involved
in those tasks. The next phase that is the development phase deals with how those tasks and support-
ing content will be taught, what learning activities will be carried out, what training materials will be
required, and what instructional methods will lead trainees to mastery of the required skills and knowl-
edge? The documents that outline the results of these development decisions are the unit plans and the
lesson plans. Likewise, the objectives suggest what activities would be appropriate, what materials are
needed, and what methods should be employed for the training program. Variety of media and meth-
ods can be considered for use such as power-point presentations, small group discussion, workshop,
conferences, closed-circuit television, online computer instruction, competency-based programs, and
self-instructional module.
Stage 4: Implementation of the Program

Logically, the next phase in the system process is putting the plans into action. It involves bringing
together educators, learners, and the materials and methods needed for education.
Chapter 15.indd 334 5/18/2012 11:59:32 AM

It includes:
❑❑ Implementation of the training plan
❑❑ Conduction of actual training sessions
❑❑ Conduction of formative evaluation at regular intervals
❑❑ Documentation of training results
Stage 5: Evaluation
It includes:
❑❑ Conduction of summative evaluation
❑❑ Analyzing information collected
❑❑ Initiate corrective actions for deficiencies explored
Evaluation of in-service education program is an investigative process to determine whether the education
was cost-effective, the objectives were achieved, the sessions were interesting, and learning was applied to
the job. The purpose of evaluation is to identify the elements of the program that need improvement as well
as to specify procedures and devices for evaluating instructor effectiveness or the adequacy of facilities. It
may also provide for follow-up evaluation (evaluating trainee performance after they have been back on the
job for some time). Some important evaluation criteria that can be used include learner reaction, learning ac-
quired, behavior modified, and more importantly the overall organizational impact of the program. By care-
fully evaluating the process and product of instruction, areas of concern can be pinpointed and ensured that
the next time the training program will be modified to capitalize on its strengths and eliminate its weaknesses.
10. BENEFITS OF ONGOING IN-SERVICE EDUCATION

❑❑ Knowledge, skill, and attitude of the employees are improved
❑❑ Improved attitudes of the employees toward learning
❑❑ Employees are better prepared to manage change
❑❑ More effective in their roles
❑❑ Maximum use of resources
❑❑ Staff feels valued and show commitment to lifelong learning
❑❑ Quality assurance or quality control
❑❑ Professional enhancement and growth
11. PROBLEMS IN STAFF DEVELOPMENT

❑❑ Lack of funds and sources
❑❑ Lack of spare staff in the organization
❑❑ Lack of willingness of staff toward in-service education
❑❑ Ignorance by the management as well as top administrators
12. PREPARATION OF REPORT

At the end of training program, in-service education coordinator prepares the report of program
describing briefly all the stages concretely to submit to the management and for the purpose of future
reference. An example of such report is given in the following page.
Chapter 15.indd 335 5/18/2012 11:59:32 AM

Front Page
Report on
INSERVICE EDUCATION PROGRAMME
COLLEGE OF NURSING
DAYANAND MEDICAL COLLEGE AND HOSPITAL
“CARDIAC NURSING UPDATE-2012”

Submitted to
The Principal,
College of Nursing,
Dayanand Medical College & Hospital,
Ludhiana, Punjab
Submitted by
Anurag B Patidar
In-service education coordinator,
College of Nursing,
Dayanand Medical College & Hospital,
Ludhiana, Punjab
Page 1
Table of Contents
❑❑ Introduction
❑❑ Learning need assessment
❑❑ Details of workshop
❑❑ Aims and objectives of the workshop
❑❑ Programme schedule
❑❑ Appendices
1. Questionnaire for need assessment/pre-test/post-test
2. Master Data Sheet
3. Feedback form/evaluation of workshop
4. Attendance sheet
Chapter 15.indd 336 5/18/2012 11:59:32 AM

Page 2
Introduction
Electrocardiogram (ECG) is a permanent record of the electrical activity of heart. It is a tracing

made of the various phases of the heart action by means of an electrocardiography.
ECG is the most important single tool for the diagnosis of arrhythmia and also it helps to
diagnose other cardiac condition, e.g., myocardial infarction, injury, ischemia, and hypertrophy.
Since arrhythmias are the commonest complications among cardiac patients and can lead to death
if appropriate actions are not taken on time, majority of cardiac patient deaths occur due to these
arrhythmias. Nurses are in a good position to detect these life-threatening situations as early as
possible so that prompt action can be taken (defibrillation) and the life of the patient can be saved.
Life-threatening arrhythmias rarely occur abruptly; instead, they are preceded by less severe ar-
rhythmias. So it is the need of the hour that the nurses especially those posted in ICCU and car-
diology wards must be familiar with the identification of such arrhythmias by interpreting ECG.
Defibrillation is the only treatment of choice for life-threatening ventricular arrhythmias and
atrial fibrillations. Various technological advancements have been taken place for defibrillation
over the past 10 years. One of the important advanced equipment is AED (automated external
defibrillator) .These defibrillators automatically detect arrhythmias and give alarm for the need of
shock to the patient and then shock is delivered manually by health care personnel. Since nurses
play an important role in the management of arrhythmias, every nurse should be thorough with
the ECG interpretations, technique of defibrillation, and also working of AED.
Pages 3–5
Learning Needs Assessment
We conducted a learning need assessment survey with the help of a 20-item questionnaire among
the nurses employed in cardiology department of DMCH. This questionnaire was divided into four
domain areas related to ECG, e.g., basic of ECG, interpretation of arrhythmias, other cardiac condi-
tions, and defibrillation. On analysis, it was found that there is knowledge deficit among nurses re-
garding the ECG interpretations and use of AED. So a workshop is planned to equip the nurses with
adequate knowledge and skills to interpret ECG and prompt actions that can be taken in case of life-
threatening arrhythmias/situations. The findings of the learning needs assessment are as follows:
Overall Knowledge of Nurses
Score Obtained(MM = 20) Number of Nurses (15)

0–6 12
7–13 3
14–20 0
12 (80%) Nurses have < 32% knowledge

3 (20%) Nurses have 65% knowledge
None of the Nurses have > 65% knowledge
Chapter 15.indd 337 5/18/2012 11:59:32 AM

12
10
6
NUMBER OF NURSES
4
0
Up to 32% 32—65% 65—100%
Bar Graph: Overall Knowledge of Nurses
Bar Chart Showing Knowledge of Nurses in Each Domain Area

1. Basics of ECG
NUMBER OF NURSES
4
0
> 50% < 50%
Knowledge Knowledge
2. Interpretation of Arrhythmias
14
12
10
8
6
NUMBER OF NURSES
4
2
0
> 50% < 50%
Knowledge Knowledge
Chapter 15.indd 338 5/18/2012 11:59:33 AM

3. Interpretations of Other Cardiac Conditions
12
10
6
NUMBER OF NURSES
4
0
> 50% < 50%
4. Defibrillation
10
6
NUMBER OF NURSES
4
0
> 50% < 50%
Page 6
Objectives of the Workshop
General Objective
At the end of the workshop, participants will be able to interpret normal ECG and arrhythmic
pattern of ECG.
Specific Objectives
At the end of the workshop, participants will be able to:
❑❑ Define ECG.
❑❑ Describe the each component of ECG strip.
❑❑ Interpret the ECG strip.
❑❑ Describe common arrhythmia in ECG strip.
❑❑ Manage the various arrhythmias efficiently.
❑❑ Demonstrate the use of AED.
Chapter 15.indd 339 5/18/2012 11:59:33 AM

Page 7
Details of the Workshop
Topic: ECG interpretations

Duration: 2 days
Dates: 23-04-11 and 24-04-11
Timings: 8.30 am–5.00 pm
Venue: Dumra Auditorium, DMCH
Group: Staff nurses from cardiology wards and ICCU, DMCH,
Ludhiana
Number of participants: 15
Teaching–learning method: Lecture, discussion, demonstration
Resource person: Associate Professor Cardiology, Lecturer CON
Clinical nurse specialist, M.Sc. Nursing final-year student
Organized by: College of Nursing, DMCH, Ludhiana
Methods and Media

❑❑ Lecture cum discussion
❑❑ Practical exercise
❑❑ Demonstration in a simulated situation in the CMET hall
❑❑ Power-point presentations
Page 8
Programme Schedule
First Day
Time Activity T/L method Speaker

8.30–9.00 am Registration Co-coordinator
9.00–9.30 am Pretest
9.30–10.00 am Inauguration/Opening session Principal, CON
10.00–11.00 am Introduction to ECG and basic components Lecture Lecturer, CON
11.00–11.30 am Tea break Lecturer, CON

11.30–1.00 pm Interpretation of ECG Lecture
1.00–2.00 pm Lunch break Cardiologist
2.00–3.00 pm Common arrhythmias, their early detection Lecture Two coordinators
3.00–3.30 pm Tea break
3.30–4.30 pm Practical exercise and discussion Group work Organizer
4.30–5.00 pm Summary of the day
Chapter 15.indd 340 5/18/2012 11:59:33 AM

Second Day
Time Activity T/L method Speaker
8.30–9.00 am Review session Organizer

9.00–10.30 am Management of common arrhythmias. Lecture Cardiologist
10.30–11.00 am Tea break
11.00–1.00 pm Automated external defibrillator Lecture cum Clinical nurse
Lunch break demonstration specialist
1.00–2.00 pm Return demonstration
2.00–3.30 pm Tea break Demonstration Three co-
3.30-4.00 pm Post-test coordinators
4.00-4.30pm Feedback and closing session Organizer/co-
coordinator
Chapter 15.indd 341 5/18/2012 11:59:33 AM

APPENDIX
Learning Needs Assessment, Pretest/Posttest Questionnaire
Note: Read the following statements carefully and write the most correct option in the box provided to
the right side.
1. There are eight QRS complexes in a 6 second ECG strip, the heart rate is
(a) 48
(b) 64
(c) 80
(d) 120
2. Normal P–R interval is
(a) 0.20 s
(b) 0.03
(c) 0.04 s
(d) 0.05 s
3. P-wave in an ECG strip denotes
(a) Atrial contraction
(b) Ventricular contraction
(c) Ventricular relaxation
(d) Refractory period
4. Characteristic saw-tooth pattern in an ECG strip indicates
(a) Premature ventricular contraction
(b) Premature atrial contraction
(c) Atrial fibrillation
(d) Atrial flutter
5. The condition in which the atria and ventricle act independent of each other is called as
(a) Right-bundle branch block
(b) First-degree heart block
(c) Second-degree heart block
(d) Third-degree heart block
6. The commonly used antiarrhythmic drug is
(a) Xylocard
(b) Xylocaine
(c) Dopamine
(d) Dobutamine
7. During cardio version, electric shock is synchronized with which wave
(a) T-wave
(b) P-wave
(c) Q-wave
(d) R-wave
8. Absolute indication of defibrillation is
(a) Atrial fibrillation
(b) Ventricular fibrillation
Chapter 15.indd 342 5/18/2012 11:59:34 AM

(c) Premature ventricular contraction

(d) Asystole
9. AED stands for
(a) Automated external defibrillator
(b) Automated electric defibrillator
(c) Auto-charged external defibrillator
(d) Auto-charged electric defibrillator
10. The initial energy level delivered in the case of manual mode of defibrillation
(a) 200 joules
(b) 250 joules
(c) 300 joules
(d) 350 joules
11. The amount of pressure that should be applied on the paddles during defibrillation is
(a) 20 lbs
(b) 24 lbs
(c) 25 lbs
(d) 28 lbs
12. M-shaped QRS complex indicates
(a) Right-bundle branch block
(b) Left-bundle branch block
(c) AV block
(d) SA block
13. Which electrolyte imbalance leads to life-threatening arrhythmias
(a) Sodium
(b) Calcium
(c) Chloride
(d) Potassium
14. The IV bolus dose of lignocaine in life-threatening arrhythmias is
(a) 25–50 mg
(b) 50–100 mg
(c) 100–150 mg
(d) 150–200 mg
15. Management of complete heart block involves
(a) Pacemaker insertion
(b) Heart transplant
(c) Defibrillation
(d) Cardio version
Note: Read the following statements carefully and if the statement is true write T and if the statement is
false, write F in the box provided to the right of the statement
1. Asystole should be converted to ventricular fibrillation and the defibrillation should be done
2. In biphasic defibrillators, more energy level is required
Chapter 15.indd 343 5/18/2012 11:59:34 AM

3. During defibrillation, the synchronized button should be put “on”

4. Ventricular tachycardia is a lethal arrhythmia
5. Jelly is applied on the paddles during defibrillation to decrease transthoracic impedance
6. Prolongation of the P–R interval indicates a defect in the conduction system between
the SA node and the AV node
7. Digitalis overdose is an important cause of AV block
8. Water should not be used for cleaning the paddles of the defibrillator
9. Transcutaneous paddles are used in the AED mode
10. Maximum four cycles are allowed for defibrillation
Keys:
MCQs
1. (c) 2. (a) 3. (a) 4. (c) 5. (a) 6. (d) 7. (d) 8. (b) 9. (a) 10. (a)
11. (c) 12. (a) 13. (d) 14. (b) 15. (a).
True and false

1. T 2. F 3. F 4. T 5. T 6. F 7. T 8. T 9. T 10. F
MASTER DATA SHEET

Subjects/
Questions 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 x √ √ x √ √ x √ x x √ √ √ x √
2 x x x x x x x √ x √ x x √ x x
3 √ √ √ √ x x x x x x x x x x x
4 √ √ x x x √ x x x x √ x x x x
5 √ x √ x x √ x √ √ x √ x √ x x
6 x x x x x x x √ x x x x √ x √
7 √ √ √ x √ x x √ √ x x x x x x
8 x x x x x √ x x x x x x x x x
9 √ x √ √ x √ √ √ x x x x x x x
10 √ √ x √ √ x √ x x x x x x x x
11 √ √ √ √ x x x x x x √ x x √ √
12 √ √ √ √ √ √ √ √ x x x x √ x √
13 x √ x x x x x x x √ √ x x x x
14 x x √ x x √ x x x x x x √ x x
15 √ x x x x x x √ x √ x x x x x
Chapter 15.indd 344 5/18/2012 11:59:34 AM

MASTER DATA SHEET

Subjects/
Questions 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
16 x √ x √ x x x x x x x x √ √ x
17 √ x √ x x x x √ x √ √ x x x √
18 x √ √ x x √ √ x x x √ √ x √ x
19 √ x x x x x x x x x x √ √ x x
20 √ √ x x x x √ x x x √ x √ √ x
Evaluation of the In-Service Education Workshop

Note: Use the following codes to indicate the extent to which you agree or disagree with each of the
statements made below. Kindly encircle the appropriate one.
1—Strongly disagree
2—Disagree
3—Agree
4—Agree strongly
Aspects Related to Planning of Workshop

1. I was given sufficient information on the aims and methods of the workshop before my arrival.
1 2 3 4
2. The sessions were adequate to fulfill the objective of the program.
1 2 3 4
3. The goals of the workshop appeared to me to be of immediate interest for the professional activities.
1 2 3 4
4. It was explained to me before the program that I was to play an active participant role.
1 2 3 4
Aspects Relating to the Relevance and Utility of the Working Method

5. Working methods during the workshop encouraged me to take an active part in it.
1 2 3 4
6. I had the opportunity during the workshop of putting my new knowledge into practice.
1 2 3 4
7. Spending time on individual work during the workshop helped me to learn.
1 2 3 4
Aspects Related to the Way the Workshop was Run and to the Attitude of the Organizers
8. The organizers displayed a satisfactory open-mindedness.
1 2 3 4
9. The general atmosphere of workshop was conducive to serious work.
1 2 3 4
Chapter 15.indd 345 5/18/2012 11:59:34 AM

10. Organizers gave me opportunity for critical comment.

1 2 3 4
11. Organizers made use of any critical comments I made during the workshop.
1 2 3 4
12. Organizers make every effort to help me reach my objective for the workshop.
1 2 3 4
13. The way workshop conducted was in line with educational principles discussed.
1 2 3 4
14. Attitude of the organization was conductive for free learning.
1 2 3 4
Aspects Related to the Organization of Activities in the Time Available
15. I consider that enough time was given for individual or group discussion.
1 2 3 4
16. Enough time was devoted to clarifying the documents.
1 2 3 4
17. Enough time was given for discussion in small groups.
1 2 3 4
18. Enough time was given for practical exercise.
1 2 3 4
19. Enough time was given for individual work.
1 2 3 4
Aspects Relating to the Benefits Gained by the Participants
20. The workshop helped me to improve my knowledge.
1 2 3 4
21. The workshop helped me to develop a favorable attitude toward the systematic approach to
educational programs
1 2 3 4
22. The workshop has encouraged me to put the knowledge I have gained into the practice after the
workshop is over.
1 2 3 4
23. The workshop will help me to encourage my colleagues to learn and make use of new education methods.
1 2 3 4
Aspects Related to the Evaluation of Workshop
24. I felt that the pretest and the follow-up test helped me to make a useful assessment of knowledge
at the end.
1 2 3 4
25. The pretest was a useful exercise and shows the advantages of this technique.
1 2 3 4
26. The practical exercise showed the usefulness of feedback during the learning process.
1 2 3 4
27. I found the daily evaluation sessions useful.
1 2 3 4
Chapter 15.indd 346 5/18/2012 11:59:34 AM

Further Comments and Suggestions

__________________________________________________________________________
__________________________________________________________________________
Attendance sheet: enclosed
Signature
In-service education coordinator
DMCH, Ludhiana
Chapter 15.indd 347 6/2/2012 10:00:14 AM

CHAPTER HIGHLIGHTS
❑❑ In-service education is a type of education which is provided to the employees while they are on
the job to improve their working capacity and efficiency.
❑❑ Staff development simply refers to any efforts to improve the knowledge, skills, and attitude of an
employee so that he/she can serve with his/her maximum potentials to the health care agency. It is
the process of enhancing staff performance with specific learning activities.
❑❑ According to American Nurses’ Association, there are three components of staff development:
orientation, in-service education, and continuing education.
❑❑ Orientation is the process of making aware the new employee about the policies, procedures,
purposes, and position requirements.
❑❑ The word “in-service” implies that learning occurs within the service organization. It is that part
of continued learning that the agency offers to increase the employees’ skills, knowledge, and
attitude in relation to specific aspects of the role expectations.
❑❑ Continuing education is another concept within staff development and provides employees with the
opportunity to learn new knowledge and skills, review and add to knowledge already gained, investi-
gate new approaches in nursing, analyze and redevelop attitudes, and strengthen clinical competencies.
❑❑ Malcolm Knowles suggested that there are basic conceptual differences between adult and child
education. Knowles first used the term “andragogy” to describe adult learning which relates to the
art and science of helping adults learn.
❑❑ Skill training, administrator role, leadership training, and counseling are some of the important
areas of in-service education.
❑❑ Analysis of the learning needs of the employees/need assessment, plan and design the in-service
education program, determine training approach, development of resource materials and media, Im-
plementation of the program and evaluation are the steps of system approach to in-service education.
❑❑ Lack of funds and sources, lack of spare staff in the organization, lack of willingness of staff
toward in-service education, and ignorance are some of the problems of in-service education.
EVALUATE YOURSELF
1: Define continuing education? Explain the need of continuing education in nursing.
Q
Q 2: Define in-service education? Prepare a plan of in-service education for the staffs in your clinical area.
Q 3: Define staff development? Explain the components of staff development.
Q 4: Explain the steps of planning an in-service education program.
Q 5: Describe the principles of adult learning.
1. Harris B.M. (1989). “Inservice Education For Staff Development”, Allyan and Bacon, Inc.
2. Oldroyd D., Hall V. (1991). “Managing staff development: A handbook for secondary schools”,
London: Paul Chapman Publishing Ltd.
3. Ryan R.L. (1987). “The complete inservice staff development program: A step-by-step manual for
school administrators”, Prentice-Hall, Inc.
4. Hyett. “Nursing management hand book”, 1st edition.
5. Marquis B.L., Huston C.J. “Management decision making for nurses”.
6. Sullivan E.J., Decker P.J. “Effective leadership & management in nursing”, 6th edition.
Chapter 15.indd 348 5/18/2012 11:59:34 AM

c h a p t e r 16
Nursing Education Programs
in India
1. INTRODUCTION
The history of nursing education in India as per the available literature dates back to 250 BC when the
first very nursing school was established in Punjab, India. It was the time when only men were allowed
to enter into nursing profession. Prior to the entry of Ms. Florence Nightingale into this profession,
there was no any structured curriculum for nursing education; therefore, she made tremendous efforts to
transform the nursing education across the globe. After establishment of nursing school at Saint Thomas
Hospital, London, in 1854, she was invited to India to provide suggestions on a system of nursing for
hospital in India. It took 5 years after the visit of Nightingale when the first school of nursing was
started in the Government General Hospital, Madras, with 6 months Diploma Midwives program. Since
then, nursing education is continuously growing and radically transformed over the last 150 years; the
major milestones include establishment of Raj Kumari Amrit Kaur College of Nursing in New Delhi,
establishment of Indian Nursing Council (INC) and various state nursing councils, recommendations
of Bhore committee, and more importantly recommendations of University Education Commission
(1947–1948) which integrated nursing education with the university system in this country. INC regu-
lated the system of nursing education by establishing structured curriculum and norms for various nurs-
ing training programs, adding, modifying, and removing various programs of nursing education time to
time as per the need of health care industry and as per the structure of preuniversity education system of
India. Presently, available nursing education programs in India are as follows:
2. DIPLOMA COURSES
❑❑ ANM (Auxiliary Nurse and Midwife)
❑❑ GNM (General Nursing and Midwifery)
❑❑ Postbasic diploma in Cardiothoracic Nursing
❑❑ Postbasic diploma in Oncology Nursing
❑❑ Postbasic diploma in Psychiatric/Mental Health Nursing
❑❑ Postbasic diploma in Operation Room Nursing
❑❑ Postbasic diploma in Critical Care Nursing
❑❑ Postbasic diploma in Nurse Practitioner in Midwifery
Chapter 16.indd 349 5/18/2012 11:54:20 AM

❑❑ Postbasic diploma in Neonatal Nursing

❑❑ Postbasic diploma in Emergency and Disaster Nursing
❑❑ Postbasic diploma in Orthopaedic & Rehabilitation Nursing
❑❑ Postbasic diploma in Neuroscience Nursing
3. DEGREE COURSES
❑❑ B.Sc. Nursing (Bachelor of Science in Nursing), B.Sc. Nursing (Honors)
❑❑ Postbasic B.Sc. Nursing (Postbasic Bachelor of Science in Nursing)
❑❑ M.Sc. Nursing (Master of Science in Nursing), MN (Masters in Nursing)
❑❑ M.Phil. in Nursing (Master of Philosophy in Nursing)
❑❑ Ph.D. in Nursing (Doctorate in Philosophy)
Let us discuss all the above listed nursing education programs one by one with the latest guidelines
of the INC.
3.1. ANM (Auxiliary Nurse and Midwife)

The first ANM course in India was started at St. Mary’s Hospital, Punjab. This is the most basic type
of nursing education program to prepare nurses who can provide basic nursing and midwifery care ser-
vices to the periphery and remote areas of the country. She should be competent enough to guide or train
birth attendants, Anganwadi workers, and other community health activists. She acts as a key person to
implement all the National health and Family welfare programs at the community level. Recently, after
the launch of National Rural Health Mission in the year 2005, there is escalating need of ANM across
the country which provoked the interest of students in this nursing education program. INC has revised
the syllabus of the ANM program and the same is implemented throughout the country from the year
2006 to 2007. The revised syllabus has incorporated the following:
❑❑ NRHM components and skilled birth attendants module of ministry of health and family welfare
including the use of selected life-saving drugs and interventions of obstetrics emergencies
approved by the MOHFW
❑❑ IMNCI module for the basic health worker
❑❑ Standard safety guidelines for infection control practices
❑❑ Biomedical waste management policies
The salient features of the program are as follows:
Eligibility for Admission: A student who has passed 10th examination can apply for admission in this
program.
Age: Any age
Duration of course: 1.5 years.
Examination body: Concerned state nursing council or examination board
Registration: R.ANM
Curriculum of the ANM Program
3.2. GNM (General Nursing and Midwifery)

General nursing and midwifery course is a diploma course, the purpose of which is to produce first-line
general practitioners of nursing who can provide nursing and midwifery services to secondary or
Chapter 16.indd 350 5/18/2012 11:54:20 AM

Nursing Education Programs in India | 351
t ertiary level of health care. INC prescribed syllabus for general nursing and midwifery course first
time in the year 1951, and a special provision was made for the admission of male in GNM course
in 1954. INC has laid down the objectives of the course in the form of competency statements which
focus on the important areas in which the nurse has to demonstrate competency after completing the
course. It includes competency in assessing the nursing care needs, planning, and implementing nurs-
ing care to the clients from birth to death as per the need of the client, the use of ethical principles
in personal as well as professional life, and demonstrating basic leadership and administrative skills.
Earlier, this program was decided to phase out by the INC, but now the idea of phasing out the pro-
gram through upgradation of the school of nursing to college of nursing is kept in abeyance because of
expansion of health sector and growing need of nurses in National Rural Health Mission. The syllabus
of GNM is revised and implemented in the year 2005–06 throughout the country. The latest syllabus
includes the following:
❑❑ Internship added
❑❑ New subjects introduced
❑❑ Increased duration of the course from 3 years to 3.5 years
The salient features of the course are as follows:
Eligibility for Admission
❑❑ Any student who has passed 10+2 or equivalent preferably with science subjects with aggregate
of 40% marks is eligible to apply for admission in a school of nursing recognized by INC.
❑❑ Those who has passed 10+2 vocational ANM course from the school recognized by INC.
❑❑ ANM who has passed 10+2 or its equivalent course.
❑❑ Candidate must be medically fit.
Age: Minimum 17 years maximum 35 years. For ANM/LHV, there is no age bar.
Duration of course: 3.5 years
Examination body: Concerned state nursing council or examination board
Registration: R.N., R.M.
Curriculum of the GNM Program
First Year
1. Biological sciences
❑❑ Anatomy and physiology
❑❑ Microbiology
2. Behavioral sciences
❑❑ Psychology
❑❑ Sociology
3. Fundamentals of nursing
❑❑ Fundamentals of nursing
❑❑ First aid
❑❑ Personal hygiene
4. Community health nursing
❑❑ Community health nursing
Chapter 16.indd 351 5/18/2012 11:54:20 AM

❑❑ Environmental hygiene
❑❑ Health education
❑❑ Nutrition
5. English
Second Year
1. Medical surgical nursing-I
2. Medical surgical nursing-II
3. Mental health nursing
4. Computer education
Third Year
1. Midwifery and gynecology
2. Community health nursing-II
3. Pediatric nursing
Internship
1. Educational methods and media, teaching in practice of nursing
2. Introduction to research
3. Professional trends and adjustments
4. Administration and ward management
5. Health economics
Students are placed in clinical areas for the practice of nursing theory, medical surgical nursing,
p sychiatric nursing, pediatric nursing, midwifery, and gynecology, and for 84 hours in the area of inter-
est of the intern student as well as in community area for the practice of community health nursing. The
curriculum of this course ensures that the student should get the knowledge of basic sciences useful for
the practice of nursing as well as the specialty areas so that he/she will be competent enough to provide
nursing care to all types of patients. INC has made it compulsory to implement the curriculum as pre-
scribed across the country so that uniformity in the education of GNM students can be maintained. The
council has also prescribed minimum requirements for the establishment of GNM training schools to
make sure that students are getting adequate facilities that are necessary for their education.
Examination: Annual external exams are held by the concerned state nursing council, a student
requires minimum 75% attendance in both theory and clinical hours (although she has to complete the
prescribed clinical hours before completing the course) and at least 11 months of course. There is pro-
vision of internal and external examination and for internal examination weightage of theory marks is
25% and of practical marks it is 50% of the total marks. A student has to secure at least 50% marks in
internal as well as external examination of each subject to get pass the examination.
Diploma and registration: After completing 3.5 years of successful training, the student is given
diploma in general nursing and midwifery and is registered as R.N. and R.M. in state nursing council.
Chapter 16.indd 352 5/18/2012 11:54:20 AM

3.3. B.Sc. Nursing (Bachelor of Science in Nursing)/B.Sc. Nursing (Honors)

Before 1946, there was no any degree course available in India. It was only after the recommendations
of Bhore Committee when RAK College of Nursing was established in New Delhi with first-degree
course in nursing in India. All the colleges of nursing in India are subject to periodical inspection by
INC except the College of Nursing AIIMS, New Delhi.
The main objective of the course is to produce a degree holder nurse who can work as a first-line
provider of nursing care in various settings of health care as well as in college or school of nursing to
teach and supervise the students in clinical area. The program is specifically directed to the development
of critical thinking and leadership skills, clinical competencies, and standards required for practice of
professional nursing and midwifery and equip them with necessary knowledge and skills so that they
can make independent decisions in nursing situations and conduct research and utilize research findings
in areas of nursing practice.
The another important feature of the program is that after completion of university degree, the
candidate is eligible to apply not only for nursing jobs but also for various jobs which requires a uni-
versity degree like bank probationary officers, Indian Administrative Services, and various state-level
administrative jobs. Therefore, this degree program of nursing provides a sense of carrier security as
well as it does not create obstruction for a meritorious student who may have big dreams. Recently,
INC has revised the syllabus which has been implemented in all universities with effects from the year
2005 to 2006. It incorporated new subjects and internship as well as new format of the syllabus to have
uniform standards of the education across the country.
Eligibility for admission: A candidate who has passed 10+2 examination or equivalent with 45%
marks in aggregate with the subject of Physics, Chemistry, Biology, and English is eligible to apply for
admission in B.Sc. nursing course. Final admission to the course is done either through entrance test or
through merit of 10+2 examination. However, it depends on the college or university whether to have an
entrance test or directly admit the student on the basis of 10+2 percentage of marks. In the state Punjab,
Baba Farid University of Health Sciences, Faridkot conducts state-level entrance test to admit students
in B.Sc. Nursing course. Similarly, AIIMS College of nursing, RAK College of Nursing, National Insti-
tute of Nursing Education, PGI Chandigarh conducts entrance examination on all-India basis to admit
students in this program. The candidate must be medically fit in order to get admission in this program.
Age: Minimum age 17 years
Duration of course: Total duration of course is 4 years with 6 months of integrate practice as intern.
Examination: Examination is conducted by the university to which concerned college is affiliated.
Nowadays, there is trend of establishment of health sciences universities in various states like Punjab,
Karnataka, and Rajasthan to bring all the health care–related degrees under the control of a single uni-
versity in the particular state. Baba Farid University of Health Sciences, Faridkot (Punjab), Rajasthan
University of Health Sciences, Jaipur (Rajasthan), and Rajiv Gandhi University of Health Sciences,
Bangalore (Karnataka) have become the controlling universities of all B.Sc. Nursing colleges in their
respective state. Examinations are conducted annually. To get pass, the student has to secure minimum
50% marks separately in each subject of theory as well as practical. The weightage of internal examina-
tion for theory paper is 25% and for practical it is 50%.
Degree and registration: After the successful completion of course, the student is awarded with the
degree of Bachelor of Science in Nursing. He is registered as R.N. and R.M. in the respective state
nursing council.
Chapter 16.indd 353 5/18/2012 11:54:20 AM

Curriculum
First Year
1. English
2. Anatomy and physiology
3. Nutrition and biochemistry
4. Nursing foundation
5. Psychology
6. Microbiology
7. Introduction to computers
Second Year
1. Sociology
2. Pharmacology
3. Pathology and genetics
4. Medical surgical nursing-I (adult including geriatrics)
5. Community health nursing-I
6. Communication and education technology
Third Year
1. Medical surgical nursing-II
2. Child health nursing
3. Mental health nursing
4. Midwifery and obstetrical nursing
Fourth Year
1. Midwifery and obstetrical (practical)
2. Community health nursing-II
3. Nursing research and statistics
4. Management and education
5. Integrated practice of 1150 hours along with a research project
3.4. Postbasic B.Sc. Nursing (Postbasic Bachelor of Science in Nursing)

This program is a gateway for GNM Diploma nurses to become a bachelor of science in nursing. This
is the only program which is available as a regular as well as a distance-education program. The main
objective of the program is to upgrade the knowledge and skills of diploma nurses in the area of clinical
practice, research, education, leadership, and management so that the nurse can provide better nursing
care with the utilization of research findings and enhanced capabilities of critical thinking, independent
decision making, communication IPR, and managerial skills. They can also serve in a college of nursing
as clinical instructor to cater to the increased demand of degree nurses across the country. Indira Gandhi
National Open University, New Delhi, Vinayaka Mission University Salem, Tamil Nadu, and some other
universities are providing this program as a distance-education program which is recognized by the INC.
INC has revised the syllabus which is implemented in all the universities from the year 2005 to 2006.
Chapter 16.indd 354 5/18/2012 11:54:20 AM


1. For regular course: Any candidate who has completed GNM course after 10+2 and is registered as
a R.N. R.M. is eligible to apply for admission in PB B.Sc. course. A male nurse who is not having
registered midwife certificate should have evidence of training of similar duration in lieu of mid-
wifery in other areas as approved by INC (psychiatry nursing, TB nursing, Leprosy nursing, cancer
nursing, orthopedic nursing, OT techniques, community health nursing, ophthalmic nursing, and
neurological and neurosurgical nursing).
2. For distance education: Any candidate who has completed GNM course after 10+2 and is having
2 years experience after completing GNM is eligible to apply for admission in PB B.Sc. distance-
learning course.
Duration of course: For regular postbasic B.Sc. Nursing, the duration of the course is 2 years,
whereas it is 3 years for distance-learning course.
Examination: Exams are conducted by the university to which the concerned college or
distance-education program is affiliated.
Registration and degree: After successful completion of the course, the candidate is conferred with the
degree of Postbasic Bachelor of Science in Nursing. He/She is not required to register again in the state nurs-
ing council, but he/she may apply to the concerned council for adding up this qualification in his/her profile.
3.5. Master of Science in Nursing (M.Sc. Nursing)

Since the scope of nursing science depends on changes and advancement in the medical science.
Nowadays, medical science has advanced and branched into superspecialty areas that require specially
trained nurses in a field of specialization who can meet the requirements of a particular group of patients,
manage a specialty area with specialized knowledge and skills, and handle sophisticated equipments
and procedures in a specialty unit.
M.Sc. Nursing course intends to transform a generalist nurse into a specialist nurse as well as an
expert nursing faculty who can provide his/her services to supervise undergraduate students in specialty
clinical areas, act as faculty at college of nursing, and can take leadership position in the field of nursing
in all the settings. The course is aimed to transform a graduate nurse into an expert teacher, researcher,
manager, and leader who can assume the top positions in the nursing department in clinical as well as
teaching settings in his/her area of expertise. It also encourages accountability and commitment to life-
long learning among postgraduates which fosters improvement of quality patient’s care.
M.Sc. Nursing course was started the first time in RAK College of Nursing, Delhi University; there-
after, College of Nursing Christian Medical College Vellore and SNDT women’s university Mumbai
took initiatives to start the postgraduation in nursing sciences. Presently, a number of colleges in public
and private sector have started this program across the country.
Eligibility for admission: A candidate who has passed B.Sc. Nursing or postbasic B.Sc. Nursing
course with 55% aggregate marks from a recognized university and has obtained 1 year experience is
eligible to apply for admission into M.Sc. Nursing course. For admission into M.Sc. Nursing program
of College of Nursing AIIMS, New Delhi, there is no requirement of 1 year experience after B.Sc. or
Postbasic B.Sc. Nursing. Candidate must be registered as a R.N. (registered nurse) for admission into
specialties other than obstetric and maternal and child health nursing which requires both R.N. and R.M.
Selection criteria: Merit judged on the basis of academic record in U.G. course or selection test or
both as per the respective university regulations.
Chapter 16.indd 355 5/18/2012 11:54:20 AM

Examination: Exams are conducted by the concerned university to whom the college is affiliated.
Exams are conducted annually (CON, AIIMS, and most of the other colleges) or 6 monthly in semes-
ter system (RAK College of Nursing). A candidate has to obtain 50% in each subject separately to be
declared as pass.
Duration: Two academic years or four semesters
Registration and degree: The candidate is required to enter the additional qualification in registration
register of the state council where he/she is already registered as a R.N., R.M. After successful completion
of the course, he/she is conferred with the degree of Master of Science in nursing (specialty area) by the
university.
Specialties Areas
M.Sc. Nursing course is available into the following specialty areas across the country.
1. Medical surgical nursing
2. Psychiatric nursing
3. Pediatric nursing
4. Midwifery and Obstetrics nursing
5. Community health nursing
6. Maternal and child health nursing
In 2004, College of Nursing, AIIMS, New Delhi, started M.Sc. Nursing in the following specialty areas:
1. Cardiological and CTVS Nursing
2. Nephrological Nursing
3. Critical Care Nursing
4. Neuroscience Nursing
5. Oncological Nursing
Curriculum
First Year
1. Advance Nursing & Allied Sciences
2. Nursing Education
3. Research & Statistics
4. Clinical Nursing-I
Second Year
1. Nursing Management
2. Clinical Nursing-II
3. Thesis
3.6. M.Phil. in Nursing

M.Phil. in nursing is a course that intends to prepare nursing leaders who would contribute to the
development of theoretical basis of nursing practice and replace traditional assumption with re-
search findings to improve the nursing services. In 1986, RAK College of Nursing started M.Phil.
in Nursing.
Chapter 16.indd 356 5/18/2012 11:54:20 AM

The objectives of this higher level course is to prepare nurses for leadership positions to meet the
national priorities and the changing trends in society and to effectively deal with problems of the
profession within the existing constraint and thus act as change agents. It makes postgraduate nurse
competent enough to analyze situations and professional problems critically and to strengthen the re-
search foundations for developing research attitudes and problem-solving capabilities, with the ultimate
aim to advance the professional body of knowledge. The course was approved by the INC at its special
meeting on February 18, 1991, in New Delhi.
Eligibility for admission: Candidate should have Masters Degree in nursing or an equivalent
qualification with at least 55% marks. The final selection is done on the basis of academic record in the
U.G. and P.G. course or selection test or both as per the respective university regulations.
Duration of course: The course is available as part-time or full-time course. The duration of part-time
course is two calendar years, whereas the duration of full-time course is one calendar year.
Examination: Exams are conducted by the university.
Degree and registration: After successful completion of the course, the candidate is conferred with
the degree of master of philosophy in nursing, he/she has to apply to concerned state registration council
to enter this additional qualification.
Curriculum: There are two parts of the course.
Part I:
❑❑ Group A: Courses on research methods in nursing (total three courses)
❑❑ Group B: Courses on major aspects in nursing (total six courses)
❑❑ Group C: Courses on allied discipline (total five courses)
Examination of Part I are conducted at the end of 6 months for full time or at the end of 1 year for
part-time course.
Part II:
❑❑ Dissertation: After passing Part 1 examination, the student is required to write a dissertation.
Topic of dissertation is determined by an Advisory Panel appointed by university. The student has
to submit the dissertation at the end of year for full-time course and at the end of 2 years for part-
time course. Research supervisor should have at least 7 years experience of teaching and research
in nursing and at least 5 years of P.G. teaching experience in nursing. He/She shall be recognized
by M.Phil. Committee of the college or university.
❑❑ The college should have postgraduate department offering Master’s degree in nursing at least for
a period of 3 years and adequate facilities for clinical work, library work, etc.
3.7. Ph.D. in Nursing

It is a fact that nursing must advance along with other health professional if society is to be assured of
a balance health care program. Therefore, this highest level of degree course in nursing was established
to improve the quality of postgraduation education across the country.
Before the establishment of the National consortium for Ph.D. in nursing, there was no any doctorate
degree in nursing; although, Ph.D. degree was available for nurses in allied disciplines like adminis-
tration, education, sociology, and psychology by various universities. The INC constituted a National
Consortium in collaboration with Rajiv Gandhi University of Health Sciences, Bangalore, by linking
six premier nursing colleges of India. World Health Organization is providing technical support for the
Chapter 16.indd 357 5/18/2012 11:54:20 AM

operation of the course. The Ph.D. Consortium program is governed by the Ordinance issued by Rajiv
Gandhi University of Health Sciences, Bangalore. Recently, in 2011, Baba Farid University of Health
Sciences, Faridkot (Punjab), has also started Ph.D. in nursing program.
The candidate must have M.Phil./M.Sc. (Nursing) or a Postgraduate degree in nursing recognized by the
INC. He/she should have passed M.Sc. Nursing with a minimum of 60% marks. The final selection of
the candidate is made on the basis of all-India entrance test. Those candidates who posses M.Phil. degree
as well as have published original research article are given a weightage of 10 marks (5 marks for each).
Duration of Course
A full-time/part-time candidate should complete research work and submit the thesis to the University
within 5 years. For a part-time candidate, the maximum period for submission of thesis is 7 years.
Curriculum
❑❑ Nursing science and theory development including nursing leadership
❑❑ Nursing leadership in health care delivery system
❑❑ Philosophy of nursing science and theoretical perspectives
❑❑ Nursing theories and theory development
❑❑ Research methodology and applied statistics
Pre-Ph.D. Examination
The provisional registration of the candidate is confirmed only after he/she has passed the pre-Ph.D. ex-
amination which is conducted after the completion of 1 year from the date of provisional registration of
the candidate. Proposal defense examination is conducted after the candidate has passed the theory papers.
Submission of Thesis
Any candidate who has completed the minimum period of 3 years doing prescribed research may sub-
mit an application along with five copies of synopsis of the thesis through the Guide, the Head of the
participating institution to the Ph.D. Registration Committee for permission to submit the thesis under
intimation to the Chairperson of the Board of P.G. Nursing Studies and to the Nodal Centre.
Award of Ph.D. Degree
The degree is awarded by the Rajiv Gandhi University of Health Sciences, Bangalore, after the candi-
date successfully completes viva-voce examination.
National Consortium Study Centers for Ph.D. in Nursing
❑❑ R.A.K., College of Nursing, Delhi
❑❑ College of Nursing, C.M.C., Ludhiana
❑❑ College of Nursing, C.M.C., Vellore
❑❑ Government College of Nursing, Hyderabad
❑❑ Government College of Nursing, Thiruvananthapuram
❑❑ NIMHANS, Bangalore (Nodal Centre)
Other than the national consortium for Ph.D. in nursing, some other colleges have also started Ph.D.
programs which includes College of Nursing, AIIMS, New Delhi; Dr DY Patil College of Nursing,
Pune; College of Nursing, Manipal; College of Nursing, Vinayaka Mission University, Salem (Tamil
Nadu), and Baba Farid University of Health Sciences, Faridkot (Punjab).
Chapter 16.indd 358 5/18/2012 11:54:20 AM

4. POSTBASIC DIPLOMA PROGRAMS

Postbasic diploma programs in various specialties areas have been developed and approved by the INC
to keep pace with the rapid changes in medical science field as well as mandates of National Health
Policy 2002. The purpose of these programs is to cater to the growing need of specialty clinical nurses
who can work efficiently and effectively in an area of specialty and can provide quality nursing care
to the patients. Besides that, she should be competent enough to teach nurses, allied health profession-
als, patients, and communities in areas related to specialty and conduct research in areas of specialty.
These postbasic diploma programs are available in selected specialty areas in various colleges of
nursing across the country.
Eligibility for admission: A candidate who is R.N. & R.M. with 1 year clinical experience can apply
for admission to any specialty area of his/her interest in a college where the program is in existence.
Duration of course: One year full-time course
Examination: Examinations are conducted by either the state nursing council or the university to
which the college is affiliated.
Specialty areas: Postbasic diploma programs are available into the following specialty areas:
❑❑ Postbasic diploma in Cardiothoracic Nursing
❑❑ Postbasic diploma in Oncology Nursing
❑❑ Postbasic diploma in Psychiatric/Mental Health Nursing
❑❑ Postbasic diploma in Operation Room Nursing
❑❑ Postbasic diploma in Critical Care Nursing
❑❑ Postbasic diploma in Nurse Practitioner in Midwifery
❑❑ Postbasic diploma in Neonatal Nursing
❑❑ Postbasic diploma in Emergency and Disaster Nursing
❑❑ Postbasic diploma in Orthopaedic & Rehabilitation Nursing
❑❑ Postbasic diploma in Neuroscience Nursing
A candidate can choose any program of specialty of his/her interest.
Problems with the Postbasic Diploma Programs
These specialty programs are struggling with the shortage of students because of the following reasons:
1. These programs are 1-year full-time programs for which an RN has to leave his/her job to join the
program which is not in the benefit of his/her economic and family life.
2. Practically, no benefit is provided to R.N. in terms of salary perks and promotions after the
completion of the course.
3. No encouragement in terms of study leave or promotion is provided by the employers to join the
program.
4. Institutes are facing acute shortage of the candidates for these programs, and many of them have
shut down the same.
Hence, it is the need of hour that these programs should be made available on the job so that more
students who are knowledge loving can be attracted to get admit in these specialty courses.
In order to improve the quality of education, INC have modified some norms related to physical and
teaching facilities in educational institutes. Now, it is mandatory for all nursing institutions to have own
buildings instead of rented buildings, provision of hostel is mandatory, and any teacher who leaves the
institution in the middle of academic year is liable to disciplinary actions and his/her registration may
be cancelled by the state council.
Chapter 16.indd 359 5/18/2012 11:54:20 AM

CHAPTER HIGHLIGHTS
❑❑ ANM is the most basic type of education program to prepare nurses who can provide basic nurs-
ing and midwifery care services to the periphery and remote areas of the country.
❑❑ INC has revised the syllabus of the ANM program and the same is implemented throughout the
country from the year 2006 to 2007. The revised syllabus has incorporated the NRHM compo-
nents and skilled birth attendants module of ministry of health and family welfare including the
use of selected life-saving drugs and interventions of obstetrics emergencies approved by the
MOHFW, IMNCI module for basic health worker, standard safety guidelines for infection control
practices, and biomedical waste management policies.
❑❑ General nursing and midwifery course is a diploma course, the purpose of which is to produce
first-line general practitioners of nursing who can provide nursing and midwifery services to sec-
ondary or tertiary level of health care.
❑❑ INC prescribed syllabus for general nursing and midwifery course the first time in 1951, and a
special provision was made for the admission of male in GNM course in 1954.
❑❑ The syllabus of GNM is revised and implemented in the year 2005–2006 throughout the country.
The latest syllabus includes the internship, new subjects introduced, and increased duration of the
course from 3 years to 3.5 years.
❑❑ Before 1946, there was no any degree course available in India. It was only after the recommenda-
tions of the Bhore Committee, RAK College of nursing was established in New Delhi with first-
degree course in nursing in India.
❑❑ The main objective of the B.Sc. nursing course is to produce a degree holder nurse who can work
as a first-line provider of nursing care in various settings of health care as well as in college or
school of nursing to teach and supervise the students in clinical area.
❑❑ INC has revised the syllabus which has been implemented in all universities with effects from the
year 2005 to 2006. It incorporated new subjects and internship as well as new format of the syl-
labus evolved to have uniform standards of the education across the country.
❑❑ Postbasic B.Sc. Nursing program is a gateway for GNM Diploma nurses to become a bachelor of
science in nursing. This is the only program which is available as a regular as well as a distance-
education program.
❑❑ M.Sc. nursing course intends to transform a generalist nurse into a specialist nurse as well as an
expert nursing faculty who can provide her services to supervise undergraduate students in spe-
cialty clinical areas, act as faculty at college of nursing, and take leadership position in the field
of nursing in all settings.
❑❑ In 2004, College of Nursing, AIIMS, New Delhi, started M.Sc. Nursing in the following specialty
areas:
❑❑ Cardiological and CTVS Nursing
❑❑ Nephrological Nursing
❑❑ Critical Care Nursing
❑❑ Neuroscience Nursing
❑❑ Oncological Nursing
❑❑ M.Phil. in nursing is a course that intends to prepare nursing leaders who would contribute to
the development of theoretical basis of nursing practice and replace traditional assumption with
research findings, with the ultimate aim of improving nursing services.
Chapter 16.indd 360 5/18/2012 11:54:20 AM

❑❑ Ph.D. in Nursing is the highest level of degree course in nursing which was established to improve
the quality of postgraduation education across the country.
❑❑ Postbasic diploma programs in various specialties areas have been developed and approved by
the INC to keep pace with the rapid changes in medical science field keeping in mind NHP, 2002.
EVALUATE YOURSELF
Q 1: Explain the recent changes made by INC in the curriculum of various nursing education programs
in India.
Q 2: Write an essay on Ph.D. nursing program: A growing need in India?
Q 3: What are the various postbasic nursing diploma courses available in India.
REFERENCES
1. Syllabus for Masters in Nursing
2. Syllabus for PhD Nursing
3. Syllabus for MPhil Nursing
4. www.indiannursingcouncil.org
Chapter 16.indd 361 5/18/2012 11:54:20 AM

Index
A Benefits of ongoing in-service education, 335

Blackboard or green board, 168
Adler’s social urge theory of motivation, 45 Bloom’s mastery learning, 204
Advantages, 169, 170, 172, 176, 177, 178, 180, 181, Branching or intrinsic style of programming, 154
184, 185, 208, 210, 264 Broader
blackboard, 169 meaning of education, 57
checklist, 229 view of the project method, 136
flash cards, 171 Bulletin board, 169
microteaching, 193
OSPE, 236 C
powerpoint, 183
Cartoon, 175
product model, 263
Changing trends, impact of socioeconomical,
rating scale, 232
political, technological changes on nursing
transparency, 179
education, 63
Advocational guidance, 295
Channels of communication, 4
Aggressive communication, 9
Characteristics, 233
Aims of education, 58
attitude, 47
Anecdotal record, 233
effective health education, 280
ANM (Auxiliary Nurse and Midwife), 350
formative assessment, 205
Areas of in-service education, 332
good test, 217
Assertive communication, 8
group, 48
Assumptions of microteaching, 192
human relations, 38
Audio aids, 181
in-service education, 331
visual aids, 181
multiple-choice questions, 224
B objective based curriculum, 269
OSPE, 235
B.Sc. Nursing (Bachelor of Science in Nursing)/B.Sc. specific objective, 96
Nursing (Honors), 353 standardized test, 215
Barriers summative assessment, 206
in interpersonal relationship, 28 the learning, 89
of communication, 12 Charts, 172
Basic principles Classification
for preparing rating scales, 232 domains of learning objectives, 96
in planning clinical rotation, 261 social group, 49
Bedside clinic, 144 Classroom management strategies, 112
Behaviorist learning theories of motivation, 45 Clinical teaching methods, 142
Behavioristic learning theories, 88 Cognitive learning theories, 88
Index.indd 362 5/18/2012 11:54:59 AM

Index | 363
Common Curriculum development, 248, 254

classroom problems, 113 action research, 271
mistakes in classroom management, 117 models, 262
problems in clinical teaching, 148
Communication, 1 D
Competency based curriculum model, 265
Defining
Competency-Based Education (CBE ), 99
health behavior, 275
Components of the specific learning
teaching, 81
objectives, 97
Definition, 2, 121, 125, 130, 137
Computer Assisted Instruction (CAI)/Computer
meaning of education, 57
Assisted Learning (CAL), 155
of AV aids, 162
Concept of
of clinical teaching, 143
learning, 87
of group, 48
measurement, assessment and evaluation, 197
Demerits of continuous comprehensive
microteaching, 189
evaluation, 211
programmed instruction, 152
Demonstration, 125
staff development, 328
Descriptive rating scale, 230
teaching, 82
Determinants of education objectives, 94, 256
Cons of
Developing media strategy for health education, 284
demonstration, 125
Development of self, 39
essay type questions, 222
Difference between
exhibition, 142
guidance and counseling, 301
field trip, 141
role play and simulation, 137
mcqs, 228
Dioramas, 175
nursing rounds, 146
Directive counseling, 304
panel discussion, 131
Disadvantages, 169, 171, 172, 173, 176, 177, 178, 180,
PBL, 151
182, 183, 184, 185, 209, 210, 232, 236
process recording, 148
of the blackboard, 169
role play, 139
of the transparency, 180
simulation, 129
Disciplinary problems, 317
small group discussion, 125
Discriminating index, 244
standardized tests, 216
Discussion, 123
symposium, 132
Distance education, 65
the discussion method, 124
Distracter effectiveness, 244
the lecture method, 122
Domains of classroom management, 112
the lecture-cum-demonstration method, 127
Drives, 41
the seminar method, 130
the workshop technique, 134 E
Constructing items for likert scale, 239
Contents of health education, 280 Eclectic approach of counseling, 306
Continuing education, 330 Education
Core curriculum, 249 commission reports, 73
Counseling, 297 objectives, 255
Crisis management plan, 320 Educational
Criteria for the selection of learning experience, 259 aims and objectives, 94
Criterion-referenced evaluation, 209 determinants, 253
Critical incident technique, 234 guidance, 295
Criticism of product model, 263 reforms, 73
Index.indd 363 5/18/2012 11:54:59 AM

Effectiveness of distance education, 66 G

Elements of communication, 3
Essay type questions, 219 General objectives, 95
Evaluation GNM (General Nursing and Midwifery), 350
of attitude, 237 Goal-oriented theory of cognitivism, 45
of skills, 228 Graphs, 173
strategies in CBC, 267 Group
Execution of cohesiveness, 51
group discussion, 123 conference, 146
panel discussion, 131 counseling, 307
Exhibition, 141 development, 50
Existentialism, 72 dynamics, 50
Explicit (expressed) or overt or written or official Guidance, 293
curriculum, 250 Guideline
External examination, 207 for effective use of bulletin board, 170
for making effective leaflets, 177
for overhead projector, 178
F for panelists, 131
to construct good mcqs, 227
Facilitating communication, 15
to improve the lecture method, 122
Facilitators of communication, 17
to make effective powerpoint slides and
Factors influencing
presentation, 182
communication, 10
to prepare charts, 172
social behavior, 40
Guttman scale, 240
validity, 218
Features of
branching program, 154
H
linear style of programming, 154 Harry Stack Sullivan interpersonal relations
Field trip, 140 theory, 35
Films, 184 Health
Flannel board, 169 belief model, 276
Flash cards, 171 education, 279
Flip chart, 171 education in india, 287
Forces & issues influencing curriculum guidance, 295
development, 252 History and trends in development, 61
Formal Hull’s drive reduction theory of motivation, 44
communication, 7 Human relation, 38
education, 65 in the context of nursing, 53
Format of Humanistic learning theories, 88
lesson plan, 104
non-standardized tests, 216 I
Formative assessment, 202, 205
produce, 205 Idealism (idea-ism), 68
Formulation of philosophy of nursing education Implicit (or hidden) or covert curriculum, 250
programme, 254 Importance
Four key components of educational of human relations, 39
objectives, 257 teaching skills, 193
Freud’s psychoanalytic theory of motivation, 44 Incentives, 41
Index.indd 364 5/18/2012 11:54:59 AM

Index | 365
Individual Linear
and group approach to health education, 282 or extrinsic style of programming, 154
and group, 48 prescriptive model, 262
conference, 146
Informal M
communication, 7
education, 65 M.Phil. in Nursing, 356
Information, education, and communication for Management of crisis and referral, 319
health, 275 Managing disciplinary problems, 317
In-service education, 330 Maslow’s self-actualization theory, 45
Institutional curriculum, 250 Mass
Instructional curriculum, 250 approach for health education, 283
Integrated curriculum, 250 media campaign, 284
Intermediate objectives, 95 Master of Science in Nursing (M.Sc. Nursing), 355
Internal assessment, 207, 208 Matching type, 227
Interpersonal Maxims of teaching, 85
communication, 8 McDougall’s theory of instinct, 44
relationship, 24 Meaning
Intrapersonal communication, 7 and definition, 248, 293, 297.
Item analysis, 242 of philosophy, 67
Measure to improve reliability, 219
Members involved in panel discussion, 131
J
Merits of formative assessments, 206
Johari window, 32 Meta communication, 7
Microteaching, 188
K cycle, 190
Models, 176
Key concepts in the selection and use of Motivation, 42
media, 164 Multimedia, 181
Kolb’s learning styles model, 92 Multiple-choice questions, 224
L N
LCD Projector, 181 Narrow meaning of education, 57
Leaflets, 177 National
Learning styles, 91 education commission (Kothari Commission),
Lecture method, 121 1964–66, 74
Lecture-cum-demonstration method, 126 education policy, 1986, 75
Lesson plan, 101 policy on education, 1968, 75
Levels Naturalism, 71
in cognitive domain, 96 Nature
of affective domain, 97 and scope of in-service education, 328
of communication, 7 of the learning, 88
of psychomotor or cognitive domain, 97 Need
Likert scale, 238 at nursing educational institution, 299
Limitations for counseling services, 298
of checklist, 229 for guidance, 297
of the Johari window, 35 for in-service education, 330
Index.indd 365 5/18/2012 11:54:59 AM

of counseling in general, 299 Personal

of counseling services at nurses’ workplace guidance, 295
setting, 300 preparation, 310
of objective based curriculum, 269 Ph.D. in Nursing, 357
Nonassertive communication, 8 Phases
Nondirective counseling approach, 305 in process recording, 148
Nonformal education, 65 of interpersonal relationship, 27
Non-standardized tests, 216 of microteaching, 191
Nontesting tools, 314 of project, 135
Nonverbal communication, 4 Philosophy
Norm-referenced evaluation, 209 of education, 67
Null curriculum, 250 of evaluation, 198
Numeric rating scale, 231 Planning
Nurse–client helping relationships, 53 for a field trip, 140
Nursing for the exhibition, 141
care plan, 147 of health education, 281
case study, 147 Postbasic
education in india, 61 B.Sc. Nursing (Postbasic Bachelor of Science in
report, 146 Nursing), 354
rounds, 145 diploma programs, 359
Poster, 171
O Powerpoint slides, 182
Pragmatism, 70
Objective
Preparation of report, 335
based curriculum, 269
Prerequisites for effective role play, 138
structured clinical examination, 236
Preventive discipline management strategies, 317
structured practical examination, 234
Principles
Objective-Based Education (OBE ), 100
for selecting learning experiences, 259
Objectivity, 219
of adult learning, 331
Objects, 175
of AV aids, 164
Observation checklist, 229
of classroom management, 111
Open curriculum, 249
of counseling, 301
Organization
of curriculum, 251
of clinical learning experiences, 260
of evaluation, 202
of counseling services, 310
of guidance, 296
of learning experiences, 259
of health education, 282
of workshop, 133
of objective based education, 270
Organizing in-service education program, 333
of organization of learning experience, 260
Orientation, 329
of programmed instruction, 153
Origin of microteaching, 188
of teaching, 83
Osgood’s semantic differential scale, 241
Problem
OSPE stations, 235
based learning, 148
Overhead projector, 178
in counseling, 316
P in evaluation, 200
in staff development, 335
Pamphlet, 178 in the project method, 136
Panel discussion, 130 of process model of curriculum, 265
Pbl scenarios, 150 tutorials, 149
Index.indd 366 5/18/2012 11:54:59 AM

Index | 367
Process of health education, 280

model of curriculum, 264 of internal assessment, 208
of communication, 3
of evaluation, 200 Q
of objective based curriculum, 271
recording, 148 Qualities of
Programmed instruction, 151 a counselor, 307
Project method, 135 educational objectives, 96
Pros of
CAI/CAL, 156, 157. R
essay type questions, 221 Radio, 181
exhibition, 142 Rating scale, 229
field trip, 141 Realism, 69
group conference, 147 Reason-assertion type, 226
individual conference, 146 Reconstructionism, 72
MCQs, 228 Reliability, 218
nursing care plan, 147 Revised national education policy, 1992, 77
nursing case study, 147 Right of children to free and compulsory education
nursing rounds, 145 act, 2009, 77
panel discussion, 131 Role
PBL, 151 and preparation of counselor, 309
process recording, 148 in organizing a workshop, 134
role play, 139 of guidance counselor, 313
simulation, 128 of teacher in PBL, 151
small group discussion, 124 of the health educator, 288
standardized tests, 216 play, 137
symposium, 132 Rotation plan, 261
the demonstration method, 125
the discussion method, 124 S
the lecture method, 121
the lecture-cum-demonstration Salient features of
method, 126 CAI/CAL, 155
the project method, 137 programmed learning, 152
the seminar method, 130 Scope of guidance and counseling, 301
the workshop technique, 134 Selection of learning experience, 259
Psychological test, 315 Seminar, 129
Public Short-answer questions, 222
address system, 181 Simulation, 127
communication, 9 Single-best-response type, 225
Puppets, 177 Skills/techniques required for effective
Purpose, 210 counseling, 308
and functions of education, 60 Slides, 180
of AV aids, 163 Small group
of classroom management, 111 communication, 9
of curriculum, 249 discussion, 124
of evaluation, 198 Social
of guidance and counseling services, 301 attitude, 46
of guidance, 296 behavior, 40
Index.indd 367 5/18/2012 11:54:59 AM

communication, 10 Therapeutic
guidance, 295 communication, 7
learning/social cognitive theory, 278 relationships, 26
or situational learning theories, 89 Thurstone scales, 238
Societal Tools for counseling, 314
curriculum, 250 Transpersonal communication, 9
determinants, 252 Transtheoretical/stages of change model, 278
Sociometry, 241 Types of
Solution to some serious common classroom attitude scales, 238
problems, 118 AV aids, 167
Specific objectives, 95 communication, 4
Specimen, 176 counseling approaches, 304
Standardized tests, 215 curriculum, 249
Steps education, 65
for better classroom discipline, 116 educational objectives, 95
in role play, 138 evaluation, 202
in the counseling process, 302 films, 184
involved in PBL process, 149 guidance, 295
of demonstration, 125 interpersonal relations, 25
of developing competency based curriculum, 266 learning, 90
of microteaching, 189 multiple-choice questions, 225
Strategies to overcome problems in the project rating scales, 230
method, 136 short-answer questions, 223
Styles or types of programming, 153 simulation, 128
Summative assessment, 206
Supportive and corrective discipline management U
strategies, 318
Symposium, 132 Understanding self, 39
System approach to in-service education process, 332 University education commission, 1948–1949, 73
T V
Tape recorder, 181 Validity, 217

Teacher’s role in procuring and managing instructional Value of clinical teaching, 143
aids, 166 Verbal communication, 4
Teaching Visual aid
skills, 192 non-projected, 168
learning strategies in CBC, 266 printed, 177
Teamwork, 52 projected, 178
Techniques of effective communication, 18 three dimensional, 175
Television, 184 Vocational guidance, 295
The graphic rating scale, 231
The secondary education commission (mudaliar W
commission), 1952, 74 Workshop, 132
The steps in the calculation of the difficulty index, 243 Writings of educational objectives, 98
Theory of
motivation, 44 Y
planned behavior, 278
reasoned action, 278 Yashpal committee, 1992, 76
Index.indd 368 5/18/2012 11:54:59 AM

Anurag Bhai Patidar - Communication and Nursing Education-Pearson (2013)

Uploaded by

Copyright:

Available Formats

Anurag Bhai Patidar - Communication and Nursing Education-Pearson (2013)

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anurag Bhai Patidar - Communication and Nursing Education-Pearson (2013)

Uploaded by

Copyright:

Available Formats

Communication and Nursing

Frontmatter.indd 1 6/2/2012 9:47:35 AM

Frontmatter.indd 2 6/2/2012 9:47:35 AM

Frontmatter.indd 3 6/7/2012 9:23:48 AM

Frontmatter.indd 4 6/2/2012 9:47:35 AM

CHAPTER 1 REVIEW OF COMMUNICATION PROCESS 1

CHAPTER 2 INTERPERSONAL RELATIONSHIP 24

Frontmatter.indd 5 6/2/2012 9:47:35 AM

CHAPTER 3 HUMAN RELATIONS 38

CHAPTER 4 INTRODUCTION TO EDUCATION 57

CHAPTER 5 TEACHING–LEARNING PROCESS 81

Frontmatter.indd 6 6/2/2012 9:47:35 AM

11. Relationship between Teaching and Learning 94

CHAPTER 6 CLASSROOM MANAGEMENT 110

CHAPTER 7 INSTRUCTIONAL STRATEGIES 121

Frontmatter.indd 7 6/2/2012 9:47:35 AM

16. Clinical Teaching Methods 142

CHAPTER 8 EDUCATIONAL MEDIA 162

CHAPTER 9 MICROTEACHING 188

Frontmatter.indd 8 6/2/2012 9:47:35 AM

CHAPTER 10 MEASUREMENT AND EVALUATION 197

CHAPTER 11 EVALUATION TOOLS 215

CHAPTER 12 CURRICULUM DEVELOPMENT 248

Frontmatter.indd 9 6/2/2012 9:47:36 AM

8. Four Key Components of Educational Objectives 257

CHAPTER 13 INFORMATION, EDUCATION, AND

CHAPTER 14 GUIDANCE AND COUNSELING 293

Frontmatter.indd 10 6/2/2012 9:47:36 AM

CHAPTER 15 IN-SERVICE EDUCATION 328

CHAPTER 16 NURSING EDUCATION PROGRAMS IN INDIA 349

Frontmatter.indd 11 6/2/2012 9:47:36 AM

Frontmatter.indd 12 6/2/2012 9:47:36 AM

Frontmatter.indd 13 6/2/2012 9:47:36 AM

Frontmatter.indd 14 6/2/2012 9:47:36 AM

Nursing is an evolving scientific discipline. In the recent years, major thrust

Frontmatter.indd 15 6/7/2012 2:44:53 PM

Frontmatter.indd 16 6/7/2012 2:44:53 PM

Words are the most powerful drug used by mankind

Chapter 01.indd 1 5/18/2012 11:38:55 AM

Communication is represented by:

Figure 1.1 Factors that Influence Verbal Communication

Chapter 01.indd 2 5/18/2012 11:38:55 AM

3. PROCESS, ELEMENTS, AND CHANNELS OF COMMUNICATION

3.2. Elements of Communication

Figure 1.2 Communication Process

Chapter 01.indd 3 5/18/2012 11:38:56 AM

4.1. Verbal Communication

4.2. Nonverbal Communication

Chapter 01.indd 4 5/18/2012 11:38:56 AM

Figure 1.3 Types of Communication

Use simple unambiguous words

Avoid being monotonous, create variations in tone as per the requirement

Figure 1.4 Guidelines for Effective Verbal Communication

Chapter 01.indd 5 5/18/2012 11:38:57 AM

It involves the use of flashing eyes or hand movements to

It involves rolling eye movement and head nodding to

It involves taking a deep breath to demonstratc readiness to

It involves culturally determined body movements that

Chapter 01.indd 6 5/18/2012 11:38:57 AM

CHAPTER 1 REVIEW OF COMMUNICATION PROCESS 1

CHAPTER 2 INTERPERSONAL RELATIONSHIP 24

CHAPTER 3 HUMAN RELATIONS 38

CHAPTER 4 INTRODUCTION TO EDUCATION 57

CHAPTER 5 TEACHING–LEARNING PROCESS 81

CHAPTER 6 CLASSROOM MANAGEMENT 110

CHAPTER 7 INSTRUCTIONAL STRATEGIES 121

CHAPTER 8 EDUCATIONAL MEDIA 162

CHAPTER 9 MICROTEACHING 188

CHAPTER 10 MEASUREMENT AND EVALUATION 197

CHAPTER 11 EVALUATION TOOLS 215

CHAPTER 12 CURRICULUM DEVELOPMENT 248

CHAPTER 13 INFORMATION, EDUCATION, AND

CHAPTER 14 GUIDANCE AND COUNSELING 293

CHAPTER 15 IN-SERVICE EDUCATION 328

CHAPTER 16 NURSING EDUCATION PROGRAMS IN INDIA 349

8. M ETHODS OF OVERCOMING BARRIERS OF COMMUNICATION