Engagement occurs as traumatic stress influences school-based behaviors
Psychoeducation . | Assessment . | Individualized Support . |
---|---|---|
Conduct psychoeducational conversations with all students on the impact of traumatic exposure across developmental domains: social, emotional, cognitive, and academic | Informal process accompanying psychoeducation that leads to the identification of students requiring further, more intensive support | One-on-one counseling related to student's adverse experience Engagement occurs as traumatic stress influences school-based behaviors |
Note: ALIVE = Animating Learning by Integrating and Validating Experience.
The classroom is a place traditionally dedicated to academic pursuits; however, it also serves as an indicator of trauma's impact on cognitive functioning evidenced by poor grades, behavioral dysregulation, and social turbulence. ALIVE practitioners conduct weekly trauma-focused dialogues in the classroom to normalize conversations addressing trauma, to recruit and rehearse more adaptive cognitive skills, and to engage in an insight-oriented process ( Sajnani et al., 2014 ).
Using a parable as a projective tool for identification and connection, the model helps students tolerate direct discussions about adverse experiences. The ALIVE practitioner begins each academic year by telling the parable of a woman named Miss Kendra, who struggled to cope with the loss of her 10-year-old child. Miss Kendra is able to make meaning out of her loss by providing support for schoolchildren who have encountered adverse experiences, serving as a reminder of the strength it takes to press forward after a traumatic event. The intention of this parable is to establish a metaphor for survival and strength to fortify the coping skills already held by trauma-exposed middle school students. Furthermore, Miss Kendra offers early adolescents an opportunity to project their own needs onto the story, creating a personalized figure who embodies support for socioemotional growth.
Following this parable, the students’ attention is directed toward Miss Kendra's List, a poster that is permanently displayed in the classroom. The list includes a series of statements against adolescent maltreatment, comprehensively identifying various traumatic stressors such as witnessing domestic violence; being physically, verbally, or sexually abused; and losing a loved one to neighborhood violence. The second section of the list identifies what may happen to early adolescents when they experience trauma from emotional, social, and academic perspectives. The practitioner uses this list to provide information about the nature and impact of trauma, while modeling for students and staff the ability to discuss difficult experiences as a way of connecting with one another with a sense of hope and strength.
Furthermore, creating a dialogue about these issues with early adolescents facilitates a culture of acceptance, tolerance, and understanding, engendering empathy and identification among students. This fostering of interpersonal connection provides a reparative and differentiated experience to trauma ( Hartling & Sparks, 2008 ; Henderson & Thompson, 2010 ; Johnson & Lubin, 2015 ) and is particularly important given the peer-focused developmental tasks of early adolescence. The positive feelings evoked through classroom-based conversation are predicated on empathic identification among the students and an accompanying sense of relief in understanding the scope of trauma's impact. Furthermore, the consistent appearance of and engagement by the ALIVE practitioner, and the continual presence of Miss Kendra's list, effectively counters traumatically informed expectations of abandonment and loss while aligning with a public health model that attends to the impact of trauma on a regular, systemwide basis.
Participatory and Somatic Indicators for Informal Assessment during the Psychoeducation Component of the ALIVE Intervention
Participatory . | Somatic . |
---|---|
Attempting to the conversation | A disposition |
Subtle forms of | Bodily of somatic activation |
A in specific dialogue around certain trauma types | Physical displays of or |
, functions as a physical form of avoidance |
Participatory . | Somatic . |
---|---|
Attempting to the conversation | A disposition |
Subtle forms of | Bodily of somatic activation |
A in specific dialogue around certain trauma types | Physical displays of or |
, functions as a physical form of avoidance |
Notes: ALIVE = Animating Learning by Integrating and Validating Experience. Examples are derived from authors’ clinical experiences.
In addition to behavioral symptoms, the content of conversation is considered. All practitioners in the ALIVE program are mandated reporters, and any content presented that meets criteria for suspicion of child maltreatment is brought to the attention of the school leadership and ALIVE director. According to Johnson (2012) , reports of child maltreatment to the Connecticut Department of Child and Family Services have actually decreased in the schools where the program has been implemented “because [the ALIVE program is] catching problems well before they have risen to the severity that would require reporting” (p. 17).
The following demonstrates a middle school classroom psychoeducation session and assessment facilitated by an ALIVE practitioner (the first author). All names and identifying characteristics have been changed to protect confidentiality.
Ms. Skylar's seventh grade class comprised many students living in low-income housing or in a neighborhood characterized by high poverty and frequent criminal activity. During the second week of school, I introduced myself as a practitioner who was here to speak directly about difficult experiences and how these instances might affect academic functioning and students’ thoughts about themselves, others, and their environment.
After sharing the Miss Kendra parable and list, I invited the students to share their thoughts about Miss Kendra and her journey. Tyreke began the conversation by wondering whether Miss Kendra lost her child to gun violence, exploring the connection between the list and the story and his own frequent exposure to neighborhood shootings. To transition a singular connection to a communal one, I asked the students if this was a shared experience. The majority of students nodded in agreement. I referred the students back to the list and asked them to identify how someone's school functioning or mood may be affected by ongoing neighborhood gun violence. While the students read the list, I actively monitored reactions and scanned for inattention and active avoidance. Performing both active facilitation of discussion and monitoring students’ reactions is critical in accomplishing the goals of providing quality psychoeducation and identifying at-risk students for intervention.
After inspection, Cleo remarked that, contrary to a listed outcome on Miss Kendra's list, neighborhood gun violence does not make him feel lonely; rather, he “doesn't care about it.” Slumped down in his chair, head resting on his crossed arms on the desk in front of him, Cleo's body language suggested a somatized disengagement. I invited other students to share their individual reactions. Tyreke agreed that loneliness is not the identified affective experience; rather, for him, it's feeling “mad or scared.” Immediately, Greg concurred, expressing that “it makes me more mad, and I think about my family.”
Encouraging a variety of viewpoints, I stated, “It sounds like it might make you mad, scared, and may even bring up thoughts about your family. I wonder why people have different reactions?” Doing so moved the conversation into a phase of deeper reflection, simultaneously honoring the students’ voiced experience while encouraging critical thinking. A number of students responded by offering connections to their lives, some indicating they had difficulty identifying feelings. I reflected back, “Sometimes people feel something, but can't really put their finger on it, and sometimes they know exactly how they feel or who it makes them think about.”
I followed with a question: “How do you think it affects your schoolwork or feelings when you're in school?” Greg and Natalia both offered that sometimes difficult or confusing thoughts can consume their whole day, even while in class. Sharon began to offer a related comment when Cleo interrupted by speaking at an elevated volume to his desk partner, Tyreke. The two began to snicker and pull focus. By the time they gained the class's full attention, Cleo was openly laughing and pushing his chair back, stating, “No way! She DID!? That's crazy”; he began to stand up, enlisting Tyreke in the process. While this disruption may be viewed as a challenge to the discussion, it is essential to understand all behavior in context of the session's trauma content. Therefore, Cleo's outburst was interpreted as a potential avenue for further exploration of the topic regarding gun violence and difficulties concentrating. In turn, I posed this question to the class: “Should we talk about this stuff? I wonder if sometimes people have a hard time tolerating it. Can anybody think of why it might be important? Sharon, I think you were saying something about this.” While Sharon continued to share, Cleo and Tyreke gradually shifted their attention back to the conversation. I noted the importance of an individual follow-up with Cleo.
Natalia jumped back in the conversation, stating, “I think we talk about stuff like this so we know about it and can help people with it.” I checked in with the rest of the class about this strategy for coping with the impact of trauma exposure on school functioning: “So it sounds like these thoughts have a pretty big impact on your day. If that's the case, how do you feel less worried or mad or scared?” Marta quickly responded, “You could talk to someone.” I responded, “Part of my job here is to be a person to talk to one-on-one about these things. Hopefully, it will help you feel better to get some of that stuff off your chest.” The students nodded, acknowledging that I would return to discuss other items on the list and that there would be opportunities to check in with me individually if needed.
On reflection, Cleo's disruption in the discussion may be attributed to his personal difficulty emotionally managing intrusive thoughts while in school. This clinical assumption was not explicitly named in the moment, but was noted as information for further individual follow-up. When I met individually with Cleo, Cleo reported that his cousin had been shot a month ago, causing him to feel confused and angry. I continued to work with him individually, which resulted in a reduction of behavioral disruptions in the classroom.
In the preceding case example, the practitioner performed a variety of public health tasks. Foremost was the introduction of how traumatic experience may affect individuals and their relationships with others and their role as a student. Second, the practitioner used Miss Kendra and her list as a foundational mechanism to ground the conversation and serve as a reference point for the students’ experience. Finally, the practitioner actively monitored individual responses to the material as a means of identifying students who may require more support. All three of these processes are supported within the public health framework as a means toward assessment and early intervention for early adolescents who may be exposed to trauma.
Students are seen for individualized support if they display significant externalizing or internalizing trauma-related behavior. Students are either self-referred; referred by a teacher, administrator, or staff member; or identified by an ALIVE practitioner. Following the principle of immediate engagement based on emergent traumatic material, individual sessions are brief, lasting only 15 to 20 minutes. Using trauma-centered psychotherapy ( Johnson & Lubin, 2015 ), a brief inquiry addressing the current problem is conducted to identify the trauma trigger connected to the original harm, fostering cognitive discrimination. Conversation about the adverse experience proceeds in a calm, direct way focusing on differentiating between intrusive memories and the current situation at school ( Sajnani et al., 2014 ). Once the student exhibits greater emotional regulation, the ALIVE practitioner returns the student to the classroom in a timely manner and may provide either brief follow-up sessions for preventive purposes or, when appropriate, refer the student to more regular, clinical support in or out of the school.
The following case example is representative of the brief, immediate, and open engagement with traumatic material and encouragement of cognitive discrimination. This intervention was conducted with a sixth grade student, Jacob (name and identifying information changed to ensure confidentiality), by an ALIVE practitioner (the second author).
I found Jacob in the hallway violently shaking a trash can, kicking the classroom door, and slamming his hands into the wall and locker. His teacher was standing at the door, distressed, stating, “Jacob, you need to calm down and go to the office, or I'm calling home!” Jacob yelled, “It's not fair, it was him, not me! I'm gonna fight him!” As I approached, I asked what was making him so angry, but he said, “I don't want to talk about it.” Rather than asking him to calm down or stop slamming objects, I instead approached the potential memory agitating him, stating, “My guess is that you are angry for a very good reason.” Upon this simple connection, he sighed and stopped kicking the trash can and slamming the wall. Jacob continued to demonstrate physical and emotional activation, pacing the hallway and making a fist; however, he was able to recount putting trash in the trash can when a peer pushed him from behind, causing him to yell. Jacob explained that his teacher heard him yelling and scolded him, making him more mad. Jacob stated, “She didn't even know what happened and she blamed me. I was trying to help her by taking out all of our breakfast trash. It's not fair.”
The ALIVE practitioner listens to students’ complaints with two ears, one for the current complaint and one for affect-laden details that may be connected to the original trauma to inquire further into the source of the trigger. Affect-laden details in case example 2 include Jacob's anger about being blamed (rather than toward the student who pushed him), his original intention to help, and his repetition of the phrase “it's not fair.” Having met with Jacob previously, I was aware that his mother suffers from physical and mental health difficulties. When his mother is not doing well, he (as the parentified child) typically takes care of the household, performing tasks like cooking, cleaning, and helping with his two younger siblings and older autistic brother. In the past, Jacob has discussed both idealizing his mother and holding internalized anger that he rarely expresses at home because he worries his anger will “make her sick.”
I know sometimes when you are trying to help mom, there are times she gets upset with you for not doing it exactly right, or when your brothers start something, she will blame you. What just happened sounds familiar—you were trying to help your teacher by taking out the garbage when another student pushed you, and then you were the one who got in trouble.
Jacob nodded his head and explained that he was simply trying to help.
I moved into a more detailed inquiry, to see if there was a more recent stressor I was unaware of. When I asked how his mother was doing this week, Jacob revealed that his mother's health had deteriorated and his aunt had temporarily moved in. Jacob told me that he had been yelled at by both his mother and his aunt that morning, when his younger brother was not ready for school. I asked, “I wonder if when the student pushed you it reminded you of getting into trouble because of something your little brother did this morning?” Jacob nodded. The displacement was clear: He had been reminded of this incident at school and was reacting with anger based on his family dynamic, and worries connected to his mother.
My guess is that you were a mix of both worried and angry by the time you got to school, with what's happening at home. You were trying to help with the garbage like you try to help mom when she isn't doing well, so when you got pushed it was like your brother being late, and then when you got blamed by your teacher it was like your mom and aunt yelling, and it all came flooding back in. The problem is, you let out those feelings here. Even though there are some similar things, it's not totally the same, right? Can you tell me what is different?
Jacob nodded and was able to explain that the other student was probably just playing and did not mean to get him into trouble, and that his teacher did not usually yell at him or make him worried. Highlighting this important differentiation, I replied, “Right—and fighting the student or yelling at the teacher isn't going to solve this, but more importantly, it isn't going to make your mom better or have your family go any easier on you either.” Jacob stated that he knew this was true.
I reassured Jacob that I could help him let out those feelings of worry and anger connected to home so they did not explode out at school and planned to meet again. Jacob confirmed that he was willing to do that. He was able to return to the classroom without incident, with the entire intervention lasting less than 15 minutes.
In case example 2, the practitioner was available for an immediate engagement with disturbing behaviors as they were happening by listening for similarities between the current incident and traumatic stressors; asking for specific details to more effectively help Jacob understand how he was being triggered in school; providing psychoeducation about how these two events had become confused and aiding him in cognitively differentiating between the two; and, last, offering to provide further support to reduce future incidents.
Germane to the practice of school social work is the ability to work flexibly within a public health model to attend to trauma within the school setting. First, we suggest that a primary implication for school social workers is not to wait for explicit problems related to known traumatic experiences to emerge before addressing trauma in the school, but, rather, to follow a model of prevention-assessment-intervention. School social workers are in a unique position within the school system to disseminate trauma-informed material to both students and staff in a preventive capacity. Facilitating this implementation will help to establish a tone and sharpened focus within the school community, norming the process of articulating and engaging with traumatic material. In the aforementioned classroom case example, we have provided a sample of how school social workers might work with entire classrooms on a preventive basis regarding trauma, rather than waiting for individual referrals.
Second, in addition to functional behavior assessments and behavior intervention plans, school social workers maintain a keen eye for qualitative behavioral assessment ( National Association of Social Workers, 2012 ). Using this skill set within a trauma-informed model will help to identify those students in need who may be reluctant or resistant to explicitly ask for help. As called for by Walkley and Cox (2013) , we suggest that using the information presented in Table 1 will help school social workers understand, identify, and assess the impact of trauma on early adolescent developmental tasks. If school social workers engage on a classroom level in trauma psychoeducation and conversations, the information in Table 3 may assist with assessment of children and provide a basis for checking in individually with students as warranted.
Third, school social workers are well positioned to provide individual targeted, trauma-informed interventions based on previous knowledge of individual trauma and through widespread assessment ( Walkley & Cox, 2013 ). The individual case example provides one way of immediately engaging with students who are demonstrating trauma-based behaviors. In this model, school social workers engage in a brief inquiry addressing the current trauma to identify the trauma trigger, discuss the adverse experience in a calm but direct way, and help to differentiate between intrusive memories and the current situation at school. For this latter component, the focus is on cognitive discrimination and emotional regulation so that students can reengage in the classroom within a short time frame.
Fourth, given social work's roots in collaboration and community work, school social workers are encouraged to use a systems-based approach in partnering with allied practitioners and institutions ( D'Agostino, 2013 ), thus supporting the public health tenet of establishing and maintaining a link to the wider community. This may include referring students to regular clinical support in or out of the school. Although the implementation of a trauma-informed program will vary across schools, we suggest that school social workers have the capacity to use a public health school intervention model to ecologically address the psychosocial and behavioral issues stemming from trauma exposure.
As increasing attention is being given to adverse childhood experiences, a tiered approach that uses a public health framework in the schools is necessitated. Nevertheless, there are some limitations to this approach. First, although the interventions outlined here are rooted in prevention and early intervention, there are times when formal, intensive treatment outside of the school setting is warranted. Second, the ALIVE program has primarily been implemented by ALIVE practitioners; the results from piloting this public health framework in other school settings with existing school personnel, such as school social workers, will be necessary before widespread replication.
The public health framework of prevention-assessment-intervention promotes continual engagement with middle school students’ chronic exposure to traumatic stress. There is a need to provide both broad-based and individualized support that seeks to comprehensively ameliorate the social, emotional, and cognitive consequences on early adolescent developmental milestones associated with traumatic experiences. We contend that school social workers are well positioned to address this critical public health issue through proactive and widespread psychoeducation and assessment in the schools, and we have provided case examples to demonstrate one model of doing this work within the school day. We hope that this article inspires future writing about how school social workers individually and systemically address trauma in the school system. In alignment with Walkley and Cox (2013) , we encourage others to highlight their practice in incorporating trauma-informed, school-based programming in an effort to increase awareness of effective interventions.
Card , N. A. , Stucky , B. D. , Sawalani , G. M. , & Little , T. D. ( 2008 ). Direct and indirect aggression during childhood and adolescence: A meta-analytic review of gender difference, intercorrelations, and relations to maladjustment . Child Development, 79 , 1185 – 1229 .
Google Scholar
Casey , B. J. , & Caudle , K. ( 2013 ). The teenage brain: Self control . Current Directions in Psychological Science, 22 ( 2 ), 82 – 87 .
Chafouleas , S. M. , Johnson , A. H. , Overstreet , S. , & Santos , N. M. ( 2016 ). Toward a blueprint for trauma-informed service delivery in schools . School Mental Health, 8 ( 1 ), 144 – 162 .
Chanmugam , A. , & Teasley , M. L. ( 2014 ). What should school social workers know about children exposed to intimate partner violence? [Editorial]. Children & Schools, 36 , 195 – 198 .
Cook , A. , Spinazzola , J. , Ford , J. , Lanktree , C. , Blaustein , M. , Cloitre , M. , et al. . ( 2005 ). Complex trauma in children and adolescents . Psychiatric Annals, 35 , 390 – 398 .
D'Agostino , C. ( 2013 ). Collaboration as an essential social work skill [Resources for Practice] . Children & Schools, 35 , 248 – 251 .
Durlak , J. A. , Weissberg , R. P. , Dymnicki , A. B. , Taylor , R. D. , & Schellinger , K. B. ( 2011 ). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions . Child Development, 82 , 405 – 432 .
Frydman , J. S. , & McLellan , L. ( 2014 ). Complex trauma and executive functioning: Envisioning a cognitive-based, trauma-informed approach to drama therapy. In N. Sajnani & D. R. Johnson (Eds.), Trauma-informed drama therapy: Transforming clinics, classrooms, and communities (pp. 179 – 205 ). Springfield, IL : Charles C Thomas .
Google Preview
Hartling , L. , & Sparks , J. ( 2008 ). Relational-cultural practice: Working in a nonrelational world . Women & Therapy, 31 , 165 – 188 .
Henderson , D. , & Thompson , C. ( 2010 ). Counseling children (8th ed.). Belmont, CA : Brooks-Cole .
Iachini , A. L. , Petiwala , A. F. , & DeHart , D. D. ( 2016 ). Examining adverse childhood experiences among students repeating the ninth grade: Implications for school dropout prevention . Children & Schools, 38 , 218 – 227 .
Jaycox , L. H. , Kataoka , S. H. , Stein , B. D. , Langley , A. K. , & Wong , M. ( 2012 ). Cognitive behavioral intervention for trauma in schools . Journal of Applied School Psychology, 28 , 239 – 255 .
Johnson , D. R. ( 2012 ). Ask every child: A public health initiative addressing child maltreatment [White paper]. Retrieved from http://www.traumainformedschools.org/publications.html
Johnson , D. R. , & Lubin , H. ( 2015 ). Principles and techniques of trauma-centered psychotherapy . Arlington, VA : American Psychiatric Publishing .
Moon , J. , Williford , A. , & Mendenhall , A. ( 2017 ). Educators’ perceptions of youth mental health: Implications for training and the promotion of mental health services in schools . Child and Youth Services Review, 73 , 384 – 391 .
Moradi , A. R. , Neshat Doost , H. T. , Taghavi , M. R. , Yule , W. , & Dalgleish , T. ( 1999 ). Everyday memory deficits in children and adolescents with PTSD: Performance on the Rivermead Behavioural Memory Test . Journal of Child Psychology and Psychiatry, 40 , 357 – 361 .
National Association of Social Workers . ( 2012 ). NASW standards for school social work services . Retrieved from http://www.naswdc.org/practice/standards/NASWSchoolSocialWorkStandards.pdf
Oehlberg , B. ( 2008 ). Why schools need to be trauma informed . Trauma and Loss: Research and Interventions, 8 ( 2 ), 1 – 4 .
Overstreet , S. , & Chafouleas , S. M. ( 2016 ). Trauma-informed schools: Introduction to the special issue . School Mental Health, 8 ( 1 ), 1 – 6 .
Overstreet , S. , & Matthews , T. ( 2011 ). Challenges associated with exposure to chronic trauma: Using a public health framework to foster resilient outcomes among youth . Psychology in the Schools, 48 , 738 – 754 .
Perfect , M. , Turley , M. , Carlson , J. S. , Yohannan , J. , & Gilles , M. S. ( 2016 ). School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990 to 2015 . School Mental Health, 8 ( 1 ), 7 – 43 .
Perry , D. L. , & Daniels , M. L. ( 2016 ). Implementing trauma-informed practices in the school setting: A pilot study . School Mental Health, 8 ( 1 ), 177 – 188 .
Porche , M. V. , Costello , D. M. , & Rosen-Reynoso , M. ( 2016 ). Adverse family experiences, child mental health, and educational outcomes for a national sample of students . School Mental Health, 8 ( 1 ), 44 – 60 .
Sajnani , N. , Jewers-Dailley , K. , Brillante , A. , Puglisi , J. , & Johnson , D. R. ( 2014 ). Animating Learning by Integrating and Validating Experience. In N. Sajnani & D. R. Johnson (Eds.), Trauma-informed drama therapy: Transforming clinics, classrooms, and communities (pp. 206 – 242 ). Springfield, IL : Charles C Thomas .
Saltzman , W. R. , Steinberg , A. M. , Layne , C. M. , Aisenberg , E. , & Pynoos , R. S. ( 2001 ). A developmental approach to school-based treatment of adolescents exposed to trauma and traumatic loss . Journal of Child and Adolescent Group Therapy, 11 ( 2–3 ), 43 – 56 .
Sibinga , E. M. , Webb , L. , Ghazarian , S. R. , & Ellen , J. M. ( 2016 ). School-based mindfulness instruction: An RCT . Pediatrics, 137 ( 1 ), e20152532 .
Tucker , C. , Smith-Adcock , S. , & Trepal , H. C. ( 2011 ). Relational-cultural theory for middle school counselors . Professional School Counseling, 14 , 310 – 316 .
Turner , H. A. , Shattuck , A. , Finkelhor , D. , & Hamby , S. ( 2017 ). Effects of poly-victimization on adolescent social support, self-concept, and psychological distress . Journal of Interpersonal Violence, 32 , 755 – 780 .
van der Kolk , B. A. ( 2005 ). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories . Psychiatric Annals, 35 , 401 – 408 .
Van Duijvenvoorde , A.C.K. , & Crone , E. A. ( 2013 ). The teenage brain: A neuroeconomic approach to adolescent decision making . Current Directions in Psychological Science, 22 ( 2 ), 114 – 120 .
Walkley , M. , & Cox , T. L. ( 2013 ). Building trauma-informed schools and communities [Trends & Resources] . Children & Schools, 35 , 123 – 126 .
Wigfield , A. W. , Lutz , S. L. , & Wagner , L. ( 2005 ). Early adolescents’ development across the middle school years: Implications for school counselors . Professional School Counseling, 9 ( 2 ), 112 – 119 .
Woodbridge , M. W. , Sumi , W. C. , Thornton , S. P. , Fabrikant , N. , Rouspil , K. M. , Langley , A. K. , & Kataoka , S. H. ( 2016 ). Screening for trauma in early adolescence: Findings from a diverse school district . School Mental Health, 8 ( 1 ), 89 – 105 .
Month: | Total Views: |
---|---|
August 2017 | 5 |
September 2017 | 34 |
October 2017 | 112 |
November 2017 | 163 |
December 2017 | 85 |
January 2018 | 75 |
February 2018 | 83 |
March 2018 | 115 |
April 2018 | 160 |
May 2018 | 76 |
June 2018 | 83 |
July 2018 | 105 |
August 2018 | 342 |
September 2018 | 273 |
October 2018 | 339 |
November 2018 | 307 |
December 2018 | 308 |
January 2019 | 52 |
February 2019 | 67 |
March 2019 | 86 |
April 2019 | 97 |
May 2019 | 67 |
June 2019 | 116 |
July 2019 | 220 |
August 2019 | 213 |
September 2019 | 299 |
October 2019 | 312 |
November 2019 | 387 |
December 2019 | 222 |
January 2020 | 235 |
February 2020 | 389 |
March 2020 | 291 |
April 2020 | 488 |
May 2020 | 154 |
June 2020 | 337 |
July 2020 | 298 |
August 2020 | 283 |
September 2020 | 494 |
October 2020 | 583 |
November 2020 | 535 |
December 2020 | 385 |
January 2021 | 332 |
February 2021 | 543 |
March 2021 | 582 |
April 2021 | 617 |
May 2021 | 401 |
June 2021 | 361 |
July 2021 | 342 |
August 2021 | 314 |
September 2021 | 388 |
October 2021 | 468 |
November 2021 | 396 |
December 2021 | 310 |
January 2022 | 244 |
February 2022 | 349 |
March 2022 | 362 |
April 2022 | 441 |
May 2022 | 236 |
June 2022 | 264 |
July 2022 | 240 |
August 2022 | 202 |
September 2022 | 258 |
October 2022 | 355 |
November 2022 | 345 |
December 2022 | 276 |
January 2023 | 228 |
February 2023 | 358 |
March 2023 | 408 |
April 2023 | 436 |
May 2023 | 292 |
June 2023 | 248 |
July 2023 | 226 |
August 2023 | 203 |
September 2023 | 248 |
October 2023 | 304 |
November 2023 | 429 |
December 2023 | 333 |
January 2024 | 189 |
February 2024 | 264 |
March 2024 | 362 |
April 2024 | 563 |
May 2024 | 315 |
June 2024 | 225 |
Citing articles via.
Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide
Sign In or Create an Account
This PDF is available to Subscribers Only
For full access to this pdf, sign in to an existing account, or purchase an annual subscription.
Advertisement
141k Accesses
16 Citations
Explore all metrics
Developmental theorists use their research to generate philosophies on children’s development. They organize and interpret data based on a scheme to develop their theory. A theory refers to a systematic statement of principles related to observed phenomena and their relationship to each other. A theory of child development looks at the children's growth and behavior and interprets it. It suggests elements in the child's genetic makeup and the environmental conditions that influence development and behavior and how these elements are related. Many developmental theories offer insights about how the performance of individuals is stimulated, sustained, directed, and encouraged. Psychologists have established several developmental theories. Many different competing theories exist, some dealing with only limited domains of development, and are continuously revised. This article describes the developmental theories and their founders who have had the greatest influence on the fields of child development, early childhood education, and care. The following sections discuss some influences on the individuals’ development, such as theories, theorists, theoretical conceptions, and specific principles. It focuses on five theories that have had the most impact: maturationist, constructivist, behavioral, psychoanalytic, and ecological. Each theory offers interpretations on the meaning of children's development and behavior. Although the theories are clustered collectively into schools of thought, they differ within each school.
This is a preview of subscription content, log in via an institution to check access.
Price includes VAT (Russian Federation)
Instant access to the full article PDF.
Rent this article via DeepDyve
Institutional subscriptions
The author is grateful to Mary Jalongo for her expert editing and her keen eye for the smallest details.
Although Watson was the first to maintain explicitly that psychology was a natural science, behaviorism in both theory and practice had originated much earlier than 1913. Watson offered a vital incentive to behaviorism, but several others had started the process. He never stated to have created “behavioral psychology.” Some behaviorists consider him a model of the approach rather than an originator of behaviorism (Malone, 2014 ). Still, his presence has significantly influenced the status of present psychology and its development.
Alschuler, R., & Hattwick, L. (1947). Painting and personality . University of Chicago Press.
Google Scholar
Axline, V. (1974). Play therapy . Ballentine Books.
Berk, L. (2021). Infants, children, and adolescents . Pearson.
Bijou, S. W. (1975). Development in the preschool years: A functional analysis. American Psychologist, 30 (8), 829–837. https://doi.org/10.1037/h0077069
Article Google Scholar
Bijou, S. W. (1977). Behavior analysis applied to early childhood education. In B. Spodek & H. J. Walberg (Eds.), Early childhood education: Issues and insights (pp. 138–156). McCutchan Publishing Corporation.
Boghossion, P. (2006). Behaviorism, constructivism, and Socratic pedagogy. Educational Philosophy and Theory, 38 (6), 713–722. https://doi.org/10.1111/j.1469-5812.2006.00226.x
Bower, B. (1986). Skinner boxing. Science News, 129 (6), 92–94. https://doi.org/10.2307/3970364
Briner, M. (1999). Learning theories . University of Colorado.
Bronfenbrenner, U. (1974). Developmental research, public policy, and the ecology of childhood. Child Development, 45 (1), 1–5. https://doi.org/10.2307/1127743
Bronfenbrenner, U. (1979). The ecology of human development . Harvard University Press.
Bruner, J. S. (1960). The process of education . Harvard University Press.
Bruner, J. S. (1990). Acts of meaning . Harvard University Press.
Bruner, J. (2004). A short history of psychological theories of learning. Daedalus, 133 (1), 13–20. https://doi.org/10.1162/001152604772746657
Coles, R., Hunt, R., & Maher, B. (2002). Erik Erikson: Faculty of Arts and Sciences Memorial Minute. Harvard Gazette Archives . http://www.hno.harvard.edu/gazette/2002/03.07/22-memorialminute.html
Editors of Encyclopaedia Britannica. (2020). Erik Erikson . https://www.britannica.com/biography/Erik-Erikson
Erikson, E. H. (1950). Childhood and society . Norton.
Freud, A. (1935). Psychoanalysis for teachers and parents . Emerson Books.
Friedman, L. J. (1999). Identity’s architect: A biography of Erik H . Scribner Publishing Company.
Gesell, A. (1928). In infancy and human growth . Macmillan Co.
Book Google Scholar
Gesell, A. (1933). Maturation and the patterning of behavior. In C. Murchison (Ed.), A handbook of child psychology (pp. 209–235). Russell & Russell/Atheneum Publishers. https://doi.org/10.1037/11552-004
Chapter Google Scholar
Gesell, A., & Ilg, F. L. (1946). The child from five to ten . Harper & Row.
Gesell, A., Ilg, F. L., & Ames, L. B. (1978). Child behavior . Harper & Row.
Gesell, A., & Thompson, H. (1938). The psychology of early growth, including norms of infant behavior and a method of genetic analysis . Macmillan Co.
von Glasersfeld, E. (1995). Radical constructivism: A way of knowing and learning . Falmer.
von Glasersfeld, E. (2005). Introduction: Aspects of constructivism. In C. T. Fosnot (Ed.), Constructivism: Theory, perspectives and practice (pp. 3–7). Teachers College.
Graham, S., & Weiner, B. (1996). Theories and principles of motivation. In D. C. Berliner & R. C. Calfee (Eds.), Handbook of educational psychology (pp. 63–84). Macmillan Library Reference.
Gray, P. O., & Bjorklund, D. F. (2017). Psychology (8th ed.). Worth Publishers.
Hilgard, E. R. (1987). Psychology in America: A historical survey . Harcourt Brace Jovanovich.
Hunt, J. . Mc. V. (1961). Intelligence and experience . Ronald Press.
Jenkins, E. W. (2000). Constructivism in school science education: Powerful model or the most dangerous intellectual tendency? Science and Education, 9 , 599–610. https://doi.org/10.1023/A:1008778120803
Jones, M. G., & Brader-Araje, L. (2002). The impact of constructivism on education: Language, discourse, and meaning. American Communication Studies, 5 (3), 1–1.
Kamii, C., & DeVries, R. (1978/1993.) Physical knowledge in preschool education: Implications of Piaget’s theory . Teachers College Press.
King, P. H. (1983). The life and work of Melanie Klein in the British Psycho-Analytical Society. The International Journal of Psycho-Analysis, 64 (Pt 3), 251–260. PMID: 6352537.
Malone, J. C. (2014). Did John B. Watson really “Found” Behaviorism? The Behavior Analyst , 37 (1) , 1–12. https://doi-org.proxy-um.researchport.umd.edu/10.1007/s40614-014-0004-3
Miller, P. H. (2016). Theories of developmental psychology (6th ed.). Worth Publishers.
Morphett, M. V., & Washburne, C. (1931). When should children begin to read? Elementary School Journal, 31 (7), 496–503. https://doi.org/10.1086/456609
Murphy, L. (1962). The widening world of childhood . Basic Books.
National Association for the Education of Young Children. (No date). Build your public policy knowledge/Head Start . https://www.naeyc.org/our-work/public-policy-advocacy/head-start
Reichling, L. (2017). The Skinner Box. Article Library. https://blog.customboxesnow.com/the-skinner-box/
Peters, E. M. (2015). Child developmental theories: A contrast overview. Retrieved from https://learningsupportservicesinc.wordpress.com/2015/11/20/child-developmental-theories-a-contrast-overview/
Piaget, J. (1963). The origins of intelligence in children . Norton.
Piaget, J. (1967/1971). Biology and knowledge: An essay on the relations between organic regulations and cognitive processes . Trans. B. Walsh. University of Chicago Press.
Safran, J. D., & Gardner-Schuster, E. (2016). Psychoanalysis. In H. S. Friedman (Ed.), Encyclopedia of mental health (2nd ed., pp. 339–347). Elsevier. https://doi.org/10.1016/B978-0-12-397045-9.00189-0
Saracho, O. N. (2017). Literacy and language: New developments in research, theory, and practice. Early Child Development and Care, 187 (3–4), 299–304. https://doi.org/10.1080/03004430.2017.1282235
Saracho, O. N. (2019). Motivation theories, theorists, and theoretical conceptions. In O. N. Saracho (Ed.), Contemporary perspectives on research in motivation in early childhood education (pp. 19–42). Information Age Publishing.
Saracho, O. N. (2020). An integrated play-based curriculum for young children. Routledge/Taylor and Francis Group . https://doi.org/10.4324/9780429440991
Saracho, O. N., & Evans, R. (2021). Theorists and their developmental theories. Early Child Development and Care, 191 (7–8), 993–1001.
Scarr, S. (1992). Developmental theories for the 1990s: Development and individual differences. Child Development, 63 (1), 1–19. https://doi.org/10.2307/1130897
Schunk, D. (2021). Learning theories: An educational perspective (8th ed.). Pearson.
Shabani, K., Khatib, M., & Ebadi, S. (2010). Vygotsky’s zone of proximal development: Instructional implications and teachers’ professional development. English Language Teaching, 3 (4), 237–248.
Skinner, B. F. (1914). About behaviorism . Jonathan Cape Publishers.
Skinner, B. F. (1938). The behavior of organisms: An experimental analysis . D. Appleton-Century Co.
Skinner, B. F. (1953/2005). Science and human behavior . Macmillan. Later published by the B. F. Foundation in Cambridge, Massachusetts.
Spodek, B., & Saracho, O. N. (1994). Right from the start: Teaching children ages three to eight . Allyn & Bacon.
Steiner, J. (2017). Lectures on technique by Melanie Klein: Edited with critical review by John Steiner (1st ed.). Routledge.
Strickland, C. E., & Burgess, C. (1965). Health, growth and heredity: G. Stanley Hall on natural education . Teachers College Press.
Thorndike, E. L. (1906). The principles of teaching . A. G. Seiler.
Torre, D. M., Daley, B. J., Sebastian, J. L., & Elnicki, D. M. (2006). Overview of current learning theories for medical educators. The American Journal of Medicine, 119 (10), 903–907. https://doi.org/10.1016/j.amjmed.2006.06.037
Vygotsky, L. S. (1934/1962). Thought and language . The MIT Press. (Original work published in 1934).
Vygotsky, L. S. (1971). Psychology of art . The MIT Press.
Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes . Harvard University Press.
Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological Review, 20 (2), 158–177. https://doi.org/10.1037/h0074428
Weber, E. (1984). Ideas influencing early childhood education: A theoretical analysis . Teachers College Press.
Download references
Authors and affiliations.
University of Maryland, College Park, USA
Olivia N. Saracho
You can also search for this author in PubMed Google Scholar
Correspondence to Olivia N. Saracho .
Publisher's note.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Reprints and permissions
Saracho, O.N. Theories of Child Development and Their Impact on Early Childhood Education and Care. Early Childhood Educ J 51 , 15–30 (2023). https://doi.org/10.1007/s10643-021-01271-5
Download citation
Accepted : 22 September 2021
Published : 29 October 2021
Issue Date : January 2023
DOI : https://doi.org/10.1007/s10643-021-01271-5
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
June 24, 2024
Quarterly Article
Tasleem J. Padamsee
Courtni Montgomery
Stefan Kienzle
Jeremy B. Straughn
Andrea Elmore
Deborah L. Fulton-Kehoe
Beryl Schulman
Thomas M. Wickizer
Gary M. Franklin
The future of the united states overdose crisis: challenges and opportunities.
The Future of Population Health
December 2022
Back to The Milbank Quarterly
Policy Points:
Context: Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers’ compensation agencies in Washington and Ohio have implemented opioid review programs (ORPs)—a form of quality improvement based on utilization review—to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient–provider relationships or clinical autonomy.
Methods: In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches.
Findings: The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers’ compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers’ compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery.
Conclusions: In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers’ compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects and are generally perceived of favorably.
Newsletter Sign-up
Get the Latest from the Milbank Memorial Fund
The Milbank Quarterly is an editorially independent multidisciplinary journal that offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.
Cookie | Duration | Description |
---|---|---|
cookielawinfo-checkbox-advertisement | 1 year | Set by the GDPR Cookie Consent plugin, this cookie is used to record the user consent for the cookies in the "Advertisement" category . |
cookielawinfo-checkbox-analytics | 11 months | This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics". |
cookielawinfo-checkbox-functional | 11 months | The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". |
cookielawinfo-checkbox-necessary | 11 months | This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary". |
cookielawinfo-checkbox-others | 11 months | This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other. |
cookielawinfo-checkbox-performance | 11 months | This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance". |
li_gc | 2 years | LinkedIn - Used to store consent of guests regarding the use of cookies for non-essential purposes |
viewed_cookie_policy | 11 months | The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data. |
Cookie | Duration | Description |
---|---|---|
__atuvc | 1 year 1 month | AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated. |
__atuvs | 30 minutes | AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated. |
bcookie | 2 years | LinkedIn sets this cookie from LinkedIn share buttons and ad tags to recognize browser ID. |
lang | session | This cookie is used to store the language preferences of a user to serve up content in that stored language the next time user visit the website. |
lidc | 1 day | LinkedIn sets the lidc cookie to facilitate data center selection. |
Cookie | Duration | Description |
---|---|---|
_ga | 2 years | The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors. |
_ga_0JXFP3TZJG | 2 years | This cookie is installed by Google Analytics. |
_gat_UA-35374969-1 | 1 minute | This is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites. |
_gcl_au | 3 months | Provided by Google Tag Manager to experiment advertisement efficiency of websites using their services. |
_gid | 1 day | Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously. |
_hjAbsoluteSessionInProgress | 30 minutes | No description available. |
_hjFirstSeen | 30 minutes | This is set by Hotjar to identify a new user’s first session. It stores a true/false value, indicating whether this was the first time Hotjar saw this user. It is used by Recording filters to identify new user sessions. |
_hjid | 1 year | This is a Hotjar cookie that is set when the customer first lands on a page using the Hotjar script. |
_hjIncludedInPageviewSample | 2 minutes | No description available. |
_hjTLDTest | session | When the Hotjar script executes we try to determine the most generic cookie path we should use, instead of the page hostname. This is done so that cookies can be shared across subdomains (where applicable). To determine this, we try to store the _hjTLDTest cookie for different URL substring alternatives until it fails. After this check, the cookie is removed. |
AnalyticsSyncHistory | 1 month | LinkedIn - Used to store information about the time a sync with the lms_analytics cookie took place for users in the Designated Countries |
at-rand | never | AddThis - Used by social sharing platform AddThis |
CONSENT | 16 years 3 months 17 days | These cookies are set via embedded youtube-videos. They register anonymous statistical data on for example how many times the video is displayed and what settings are used for playback.No sensitive data is collected unless you log in to your google account, in that case your choices are linked with your account, for example if you click “like” on a video. |
uvc | 1 year 1 month | Set by addthis.com to determine the usage of addthis.com service. |
vuid | 2 years | Vimeo installs this cookie to collect tracking information by setting a unique ID to embed videos to the website. |
xtc | 1 year 1 month | AddThis - Registers the users sharing of content via social media |
Cookie | Duration | Description |
---|---|---|
_fbp | 3 months | This cookie is set by Facebook to display advertisements when either on Facebook or on a digital platform powered by Facebook advertising, after visiting the website. |
bscookie | 2 years | This cookie is a browser ID cookie set by Linked share Buttons and ad tags. |
fr | 3 months | Facebook sets this cookie to show relevant advertisements to users by tracking user behaviour across the web, on sites that have Facebook pixel or Facebook social plugin. |
IDE | 1 year 24 days | Google DoubleClick IDE cookies are used to store information about how the user uses the website to present them with relevant ads and according to the user profile. |
loc | 1 year 1 month | AddThis sets this geolocation cookie to help understand the location of users who share the information. |
personalization_id | 2 years | Twitter sets this cookie to integrate and share features for social media and also store information about how the user uses the website, for tracking and targeting. |
test_cookie | 15 minutes | The test_cookie is set by doubleclick.net and is used to determine if the user's browser supports cookies. |
UserMatchHistory | 1 month | Linkedin - Used to track visitors on multiple websites, in order to present relevant advertisement based on the visitor's preferences. |
VISITOR_INFO1_LIVE | 5 months 27 days | A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface. |
YSC | session | YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages. |
yt-remote-connected-devices | never | YouTube sets this cookie to store the video preferences of the user using embedded YouTube video. |
yt-remote-device-id | never | YouTube sets this cookie to store the video preferences of the user using embedded YouTube video. |
yt.innertube::nextId | never | These cookies are set via embedded youtube-videos. |
yt.innertube::requests | never | These cookies are set via embedded youtube-videos. |
BMC Nursing volume 23 , Article number: 399 ( 2024 ) Cite this article
235 Accesses
Metrics details
Graduate Entry Nursing (GEN) programmes have been introduced as another entry point to nurse registration. In the development of a new GEN programme, a problem-based approach to learning was used to develop critical thinking and clinical reasoning skills of motivated and academically capable students.
To explore and evaluate the design and delivery of course material delivered to GEN students embedded in authentic learning pedagogy from the perspectives of both GEN students and academic staff using an unfolding case study approach.
An educational design research approach was used to explore the learning experiences of GEN students using an unfolding case study approach situated in experiential pedagogy and the teaching experiences of the academics who designed it. Data were collected through semi-structured interviews with students once they had finished the course and weekly reflective diary recordings by academic staff throughout implementation. Thematic analysis was used to analyse the data.
Student reflections highlighted that this cohort had insight into how they learned and were comfortable voicing their needs to academic staff. While the unfolding case studies were not liked by all participants, for some it offered a unique learning opportunity; particularly when scaffolded with podcasts, simulation labs, tutorials and clinical placements. Staff reflections primarily aligned with student experiences.
The gaps highlighted in the delivery of the course suggest that a blended pedagogical approach to graduate entry nurse education is required. Specifically, GEN students are aware of the learning needs and are happy to express these to academic staff, thus suggesting that engaging with a co-design curriculum approach will benefit future cohorts.
Peer Review reports
Graduate entry nursing students begin their degrees as experienced learners and must develop critical thinking skills within the shortened degree time frame.
Graduate entry students are experienced and academically capable learners who begin with a diverse range of life and career experiences.
Graduate entry students would benefit by being involved in curriculum design to acknowledge the unique skill set that they bring.
Graduate Entry Nursing (GEN) degrees, or second degrees leading to eligibility for nursing registration, have recently been introduced to New Zealand. GEN students are known to be academically capable, motivated, and driven, bringing with them a range of life experiences, and have often had significant careers before enrolment [ 1 , 2 ]. Previous research has identified that teaching and learning methods must be carefully planned and innovative [ 1 ].
Pre-registration nursing education programmes prepare nursing students to provide safe nursing care with crucial skills expected of nursing graduates, including critical thinking and clinical reasoning. Clinical reasoning enables students to approach clinical issues with a problem-solving lens that relies on gathering assessment data and intervening and evaluating the patient’s response to the intervention [ 3 ].
Problem-Based Learning (PBL) aligns with the fundamental elements of authentic learning approaches [ 4 ], where learning is situated in real-world contexts [ 5 ]. Problem-based learning is considered to be an experiential teaching and learning approach that helps students develop a critical lens and clinical reasoning skills [ 6 , 7 ]. The use of PBL in nursing education is well established with previous research focused on students’ experiences and satisfaction [ 8 ]; factors that facilitate or hinder students' learning [ 9 ]; and the development of critical thinking skills [ 10 ].
Graduate entry nursing students report enjoyment of the active learning sets that enabled discussion surrounding case studies, scenarios, and practice issues [ 11 ]. Cangelosi’s [ 12 ] phenomenological study found that although time-poor, GEN students welcomed learning opportunities that were not traditional and facilitated their development and growth.
However, there is conflicting evidence regarding the effectiveness of PBL in nursing. For example, McCormick et al. [ 13 ] compared undergraduate student performance using differing teaching approaches, such as unfolding simulation scenarios versus recorded lectures and found these to be of benefit to students. Carter and Welch [ 14 ] compared the results of associate degree nursing students who attended lectures to those whose learning was informed by an unfolding case study. In contrast to McCormick’s et al.’s [ 13 ] earlier positive results, these authors found both groups of students performed worse in the post-test.
As previous research has identified that new graduate nurses do not always have critical thinking skills, using an unfolding case study approach can reflect the reality of clinical practice where not all the relevant information is known at the first encounter with the patient [ 14 , 15 , 16 ].
Nonetheless, while several studies have investigated the use of unfolding case studies in undergraduate preregistration programmes there is little evidence that supports the use of these with more academically capable GEN students. This article reports on a qualitative interpretivist study that used an educational design methodology to explore the experiences of GEN students who participated in the programme of learning and the experiences of the academics who designed it.
Educational Design Research (EDR) is an iterative, pragmatic, and reflective methodology well suited to small projects [ 17 ]. It has arisen from design-based research and can include both quantitative and qualitative data collection methods. EDR was selected as it fitted with our desire to develop new ways of teaching alongside gaining feedback from both academic staff and students. In the first phase of this research, we redesigned the teaching and learning strategies for a component of the GEN programme [ 18 ].
EDR has four phases (Table 1 ) [ 17 ]:
The study aimed to explore and evaluate the design and delivery of course material delivered to GEN students embedded in authentic learning pedagogy from the perspectives of both GEN students and academic staff using an unfolding case study approach.
To enable the development of clinical reasoning skills a scaffolded learning approach was implemented that involved unfolding case studies designed to represent the health needs of the New Zealand population, thus, encouraging critical thinking. Unfolding case studies reflective of situations that students might face in the future were used to encourage students to consider and analyse information, provoke further questioning and identify the information required to narrow their inquiries [ 14 , 15 ]. Supported by this evidence the academic staff built a learning environment where a regular teaching schedule (two days of lectures and one day of clinical labs per week), was complemented with online resources. Initial questions about the case study were provided on the learning management system. Students attended simulations where they responded to the case and answered questions critical to unpacking the ‘patients’ reality. Alongside the unfolding case studies were podcasts where experts were interviewed on topics related to the case. Tutorials enabled students to collaboratively construct answers and share their perspectives; at the end of each week students shared their answers in an online discussion forum.
This study was conducted at an education facility in New Zealand offering undergraduate and GEN programmes. The participants are academics involved in the design and delivery of the course and one cohort of students of the GEN programme. This article reports on Phase 2 and 3 of the EDR approach, the academic staff’s reflective diary during course delivery, and students' feedback after the course was completed the first time. The methods were reported using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) [ 19 ].
Purposeful sampling was used as the researchers were keen to explore the experiences of a specific GEN cohort [ 20 ]. Academic staff involved in the weekly reflective diaries are also the research team ( n = 3). All students in the identified cohort ( n = 7) were invited to participate, totalling ten possible participants. Student participants were approached via an advertisement on the university’s learning management system. Students were asked to contact the research assistant, who was separate from the academic staff and was not involved in the delivery of the GEN programme; five students agreed to participate. A $20 petrol voucher was offered to those who participated.
In keeping with education design methodology, the authors met weekly to reflect on their experiences of delivering the content and guiding students. The weekly reflective conversations, between 60–90 min in length, followed a simple format of ‘what worked, what didn’t work, and what would we (as academic staff) change?’ Face to face student interviews were conducted by the research assistant at a time and place convenient to the students using semi-structured questions that were developed by the research team (see Additional file 1 ).
The semi-structured interviews ( n = 5) and reflective meetings ( n = 9) were recorded and transcribed verbatim by a research assistant who had signed a confidentiality agreement. All identifying information was deleted from the transcripts by the research assistant before the research team reviewed the data; each recording and transcript was allocated a unique identifier, for example ‘participant one’.
Thematic analysis [ 21 , 22 ] was used to analyse the data. First, the research team independently read the transcribed interviews to familiarise themselves with the data and identified initial codes. Second, the researchers met and reviewed all transcripts to identify themes and reached consensus on the themes emerging from the data. Themes were established once more than 50% of the participants stated the same issue/thought/perception. A matrix was developed whereby common themes were identified, with quotes demonstrating the themes collated to establish an audit trail.
Central to this study given the proximity of staff to this student cohort, a reflexive stance was essential. Reflexivity is an engendered practice and was used in this instance not to influence the direction and outcome of the research but to allow the researchers to engage in the data to produce viable and valuable outcomes for future staff and students. Specifically, this reflexive practice provided a means for the research to be rigorous through the consideration of the vulnerability of the participating student cohort, thus inciting reflection-before-action [ 23 ].
Ethical approval for this study was obtained from the Auckland University of Technology Ethics Committee (AUTEC) (19/233). Given the potential power differential in the student/staff relationship present, participants were approached via an online advertisement and followed up by an independent research assistant. This is key to the success of the project, as such research undertakings have the potential for conflict of interest to exist [ 24 ]. The academic staff recordings were also undertaken with the knowledge that these would remain confidential to the participants and transcriber only, with a memorandum of understanding completed to this effect. Participant information sheets were given to students interested in joining the study to ensure they knew what it entailed and how their safety and identity would be managed. Written consent was obtained before the interviews were undertaken, with oral consent obtained at the beginning of each interview.
Three dominant themes emerged, which focused on the experiences of both GEN students and teaching staff. These were:
Reflective learning: Students and staff ability to clarify what worked and what did not work
Evaluation of learning: Students and staff being insightful about their ways of learning and needs
Challenges: Planning and delivering appropriate content for GEN students is challenging for teaching staff.
Within these overarching themes, subthemes were developed and will be presented in the following data results (Table 2 ).
The exploration of student and staff experiences and responses to the unfolding case studies unearths what worked and what was problematic for both parties.
The student experiences of using an unfolding case study approach were divided. Some students enjoyed the case scenarios but did not necessarily find them beneficial in terms of knowledge advancement as.
“ I personally, like the case studies but personally I didn’t really find that they enhanced my learning in like the clinical setting ” (P1)
or that they were relevant to clinical practice in that.
“… some of it was definitely relatable but I just found it was very different in the clinical setting compared with doing this theoretical case setting ” (P1).
A second student supported this idea that the case studies did not add practical clinical knowledge value as.
“ I mean for me the case studies weren’t challenging…I didn’t think the case studies added anything extra into my practice, they didn’t challenge my clinical reasoning or anything like that ” (P2).
Of note was that those students with previous professional healthcare backgrounds found the use of an unfolding case study approach problematic in that.
“ I found that quite a challenge. I think because with my clinical background I was sort of going straight into, yeah like I wanted more information so you know I probably would have preferred…to have a different case study every week or have all the information…and I’d be like well what about this, what about that? ” (P5).
Participant One, however, noted that while the case studies may not have added knowledge value, they were helpful at times as.
“ …one example is we learnt about arterial blood gases and then I was on placement I came across that literally [on] day one, so was really nice to be able to put something that I’d learnt in class into practice ” (P1).
While some students were less keen on the case study approach and found them hard work, others thought they provided opportunities to encourage discussion, clinical reasoning, and autonomous thinking as.
“ there was no right or wrong answer, you just had to prove your point to say I think it is this because of this, and someone else can say something else and just kind of still prove it because it was a quite grey [area] but I actually found that it really got us thinking ” (P3).
Moreover, the same participant acknowledged that.
“…I think that’s the whole idea of the course [GEN Programme] because at this level they shouldn’t be spoon-feeding you…you should be able to think for yourself and reason things out ” (P3).
Although some discord was present with regard to the case study approach, one participant did acknowledge the value of being able to break down a huge scenario into manageable sections to enhance understanding and clinical decision-making, as.
“ when you break it down it makes it easier to kind of work out what you’re going to do and what steps you’re going to do ” (P4), and that “ because you start looking at the smaller things that you need to do rather than just the big bits ” (P4).
It appears, however, that staff involved in the programme of learning were pleased with the overall notion that problem-based learning approach offered a ‘practical’ means through which to discuss what is the hands-on job of nursing. Specifically,
“ the second session around child abuse and recognising child abuse…took me a bit by surprise as I wasn’t expecting that to go very well and it went extraordinarily well, mostly because it was case based again and story based ” (L1).
Moreover, with regard to encouraging discussion and clinical reasoning at a postgraduate level,
“ I think we’ve really pulled out the difference [of] what we’re expecting of them [GEN students] as opposed to what they may have been used to” (L1).
While the use of technology is not necessarily a completely new strategy in tertiary education, here we have linked podcasts recorded with experts in their fields which related to the unfolding case studies, Again, however, there was division in the value of podcast recordings, with some students really enjoying them, saying.
“ I liked the podcasts yeah, I found the podcasts really good especially when there was [sic] different people talking about it, yeah...podcasts are good, like to just chuck on in the car or at the gym ” (P2).
Moreover, some found them easy to listen to because.
“… it’s a different way to learn because like you’ve got YouTube videos and you’ve got books and stuff but podcasts are kind of like easy ” (P2).
Some students found the podcasts particularly engaging saying.
…I just remember listening to it and I think I was in the car and I had stopped because I was on my way home…and I was still listening to it in the garage like when I was home and I was like oh this is a really interesting podcast ” (P2).
Participant three also thought podcasts a positive addition to the resources saying.
“ yeah they were helpful…there was one I listened to…they were talking about dying…I know that [one of the lecturers’] kind of research is kind of talking about death, euthanasia and all this kind of thing, and for some reasons, I don’t know why, maybe that’s why I still remember, I can say it’s the only podcast I really listened to and it was really good because it gave me a good insight as to what is happening… ” (P3)
This positive response was also noted in face-to-face class time as one staff member reported that.
“ they [the students] loved the person who was interviewed, and the feedback was it was really nice to hear a conversation about different perspectives ” (L1).
Yet, not all students were of this opinion, with some advising the podcasts were too long (approximately 60 min each), that they can be distracting, that they preferred videos and images or an in-person discussion, saying.
“ I find podcasts…I tend to switch off a bit, a bit quicker than if I was watching something, I would probably prefer, rather than watching a podcast [sic] I’d rather have an in-class discussion with the person” (P4).
Participant one said that they too struggled with podcasts because.
“ I’m more visual so I like to look at things and see like a slide I guess or what they’re talking about or, so I sort of zone out when it’s just talking and nothing to look at, so that’s what I personally struggle with, they [podcasts] are helpful it’s just I’m more a visual learner ” (P1).
While there were some negative responses to the podcasts, another participant acknowledged their value but offered their own solutions to learning, saying that.
“ I listened to a few podcasts that were put up, because they’re just easy to listen to ” (P2).
but felt that overall there were insufficient resources made available to students and therefore.
“ just went to YouTube and just, any concepts that I was unfamiliar with or stuff in class that we went over and when I went home I was like [I have] no idea what they talked about, I just found my own videos on YouTube… ” (P2).
Learning experiences are unique to each GEN student, as are those experienced by the teaching staff. The data collected highlighted this clearly from both perspectives, offering a particularly strong insight into how this cohort of students’ function.
It was evident that these GEN students were aware of their approach to learning and that perhaps the structure of the teaching module did not align with their needs as.
“ I’m not really the best at utilising online things I’m a really hands on learner and things like a lecture…but you know if it’s yeah, more like class time, it’s sort of more my, my learning style [I] guess ” (P5).
A number of students were able to identify that they were visual learners as.
“ I use videos more because I guess I’m more of a visual learner as well and I learn better by seeing things instead of reading a huge article, I think that [videos] it helps me a bit more” (P4).
Another student, however, preferred a discussion based approach as opposed to either videos or podcasts saying that.
“ if it’s interesting, if it’s a topic that you can like relate to [through a podcast] or something it’s fine, but for me I just switch off not really taking a lot of the information [in] whereas in a discussion setting you can ask questions and you can interact with the person, yeah I find that would be a bit more helpful ” (P4).
This approach to learning through discussion was also noted when the teaching staff reflected on their experiences in that in one teaching session the GEN students.
“ were engaged, they were round a table with the second speaker talking and what I think enabled the discussion was that she [the speaker] was using her data as stories and so she was reading them, actually she got them [the students] to read them out” (L3).
The notion of learning styles, however, was not as linear as being visual or auditory or practical, as one student noted that a combination of styles was preferable to enhance learning, saying that.
“ if we weren’t able to have lectures like a recorded lecture so that there was a PowerPoint and just someone actually talking you through it, like I know there’s the YouTube videos…some of them were a little bit helpful, but like I just felt that sometimes we missed the teaching aspect of it. There’s a lot of self-directed stuff but definitely like a recorded lecture every week to go along with the readings and extra videos to watch ” (P5).
While GEN students are known for their tenacity and ability to cope with the pressure and fast paced delivery, some students discovered that this did not necessarily equate with their preferred approach to learning. This cohort of GEN students were insightful in terms of their strengths and weaknesses in relation to knowledge acquisition. The use of the unfolding case studies, however, caused some frustrations as.
“ for me it was challenging in the fact that I felt I actually got frustrated because I’m thinking well I want to know this, I want to know that and yeah not getting all the information that I wanted at the time ” (P5).
This participant went further, saying that.
“ I definitely found that difficult [lack of information] I felt like [I] wasn’t getting as much information as I wanted to be able to make my clinical decisions ” (P5),
however this may have been due to the student’s background as their.
“my background is in paramedicine ” where “ we get a lot of information in a very short amount of time ” (P5).
Some fundamental issues were raised by the participants in terms of how much study is required for them to acquire the new knowledge. As one student highlighted,
“ I have a really terrible memory, so I kind of need to listen to things a few times or write it down and then watch a video and do some more reading and then like it’s good having another element to get into your brain you know ” (P2).
For one student, a solution to this was to ensure they did their preparation before attending class as.
“ you’re supposed to have read these things before coming to class, some people don’t but my kind of person, I’d read before coming to class and I tended to answer those questions so the critical, analytical part of me would be trying to find out and come up with a reasonable answer…” (P3).
For another participant, they took an alternative pathway to learning as they.
“ I just watch it and I don’t take [it in], it just sits in the back of my head because sometimes it’s building on top of previous knowledge so just, I just watch it to see if I can gain anything from that, I don’t necessarily take down notes or anything, but I just watch it so that it’s there you know ” (P4).
The pace of content delivery appeared problematic for some students, especially in relation to the practical sessions, with one student highlighting that.
“ personally I didn’t’ really like it and most of the time they were rushing, I was always like can I write this down to go back home to like really make sense of it and then sometimes obviously, sometimes I would have to say can I stay back and practice this thing again [as] I didn’t grab it as quickly as others did and the essence of the labs is that it’s grab all of these things ” (P3).
While on the whole the teaching staff were able to gauge the learning needs of this GEN cohort, the expectations of both parties did not always align, with one staff member reporting that.
“ the two biggest challenges was [sic] getting them [the students] to unpack already learned behaviour and [to] acknowledge their own limitations or bias ” (L1),
however by the end of the semester the same staff member reported that.
“ I think we made a lot of progress in getting them to acknowledge how they learn ” (L1).
Moreover, the challenges anticipated in teaching GEN students were not those that transpired in that.
“ I actually thought going into the first paper I was pretty excited as to how it was going to roll out, the problems I encountered were not the problems I anticipated ” (L3).
The vocality of this cohort was tangible, however, when content did not meet their needs, interest or expectations with the students saying,
“ that they didn’t do the materials because it wasn’t of interest to them and requested other teaching very much related to the assignment as opposed to anything else …” (L1).
It was expected that the GEN students would be participatory both in class and online irrespective of their ways of learning, but there was a difference in both responses and comfort with this form of engagement. One student that talked about the unfolding case study and the online component of assessment as being problematic said that.
“.. we had to put up about 250 words of something related to the case study every week and then we spoke to someone else, [I] didn’t really like the responses…I didn’t really like having to respond to someone else ” (P3).
Yet in contrast to this statement, the teaching staff were delighted that.
“…actually I got some fantastic questions from one of the students…emailed to me on Monday night about the case that was online for them, questions that I didn’t talk about in [the] lecture, I didn’t introduce the concept…they’re talking about concepts that are currently undergoing international clinical trials” (L1).
This study explored the experiences of both GEN students and academics using unfolding case studies situated in experiential learning pedagogy. The use of unfolding case studies supported with podcasts embraced our idea of developing content situated in real-life contexts. Learning was scaffolded using different teaching approaches such as podcasts, and experiential simulated learning, to offer learners multiple ways of engaging with content. Scaffolding is recognised as learning material being broken into smaller chunks of learning and in this way aligns with case-based learning [ 25 ]. In this way, we hoped that not only would students engage in problem-solving, and develop clinical decision-making skills [ 26 , 27 ], but that they would also achieve deep and lifelong learning and ultimately have an ‘aha’ moment when it all made sense.
Findings were divided, with some students enjoying the unfolding case studies and others describing them as not sufficiently challenging. The scaffolded learning approach that we developed incorporated a range of teaching approaches that enabled them to engage with the content in a way that fitted in with their lifestyle, even if the teaching method did not align with their individual learning preferences. Students reported differing views about the case studies; some enjoyed the unfolding nature while others wanted more context and direction to feel that they could make an informed clinical decision. Nonetheless, even though they did not like information being presented in smaller chunks one student recognised it meant they analysed the information they received more deeply.
Other learning tools such as podcasts were not always valued by participants and yet, the fact that students were able to provide feedback on their use does indicate that they at least attempted to engage with them.
Student reflections indicate that perhaps the use of unfolding case studies as a learning approach is not the solution to engagement, and that often more traditional teaching methods were preferred Indeed, Hobbs and Robinson’s [ 28 ] study of undergraduate nursing students in the US supported Carter and Welch’s [ 14 ] findings that the use of unfolding case studies were of no direct benefit, whilst Ellis et al.’s., [ 29 ] study confirmed that for final year nurse practitioner students unfolding case studies were beneficial in developing critical thinking and stimulating clinical reasoning. Considering these two conflicting findings, further consideration is needed of how to engage highly motivated GEN students.
As such, our results suggest it can be difficult to predict the needs of the GEN students given the diversity of their previous academic qualifications, career, and often significant life experience they bring to the programme [ 30 , 31 ]. Interestingly students in this study simultaneously demonstrated insight into their needs supporting their previous academic study experience and felt sufficiently secure to voice them, which supports evidence found in D’Antonio et al.’s [ 32 ] study. This suggests that GEN students’ capabilities need to be embraced and incorporated when planning curriculum and scaffolding learning. Anecdotally, we have found that students embrace experiential learning such as that offered in simulation labs whether this involves the use of simulated manikins or not, it seems the hands-on learning offers not only the opportunity to experience simulated reality but also fosters collaboration and problem solving with peers that enables them to dwell in learning of what it is to be a nurse.
Our students were not overwhelmingly supportive of the pedagogical approach of unfolding case studies we adopted. As previously recognised GEN students are experienced learners and whilst having differing educational backgrounds bring individual experience and knowledge of their own approach to their learning. Nonetheless, the value of their previous learning experience appears problematic in that those learned behaviours and attitudes need to be refocused to engage with learning how to become a nurse, as demonstrated in the academic staff reflections. Despite this background experience and perceived confidence, some students reflected that online engagement that involved exploring the case studies in discussion forums with colleagues was uncomfortable. This was surprising to the academic staff and contrasted sharply with their reflections on the activity but has been previously noted by Boling et al., [ 33 ].
Given the disparity that exists between student and academic staff experiences, as demonstrated in our study, co-designing content delivery may offer a progressive solution. By engaging ‘students as partners’ it offers them a much deeper level of involvement in future teaching delivery through collaboration and reciprocation of ideas, thus culminating in appropriate curriculum design [ 34 ]. Collaborating with students in course design might facilitate students learning as they become cognisant of the active engagement of academic staff [ 9 , 10 , 35 ]. In the future, we aim to involve students in any curriculum review and course development to ensure their perspectives influence curriculum design and content delivery.
Even so, our initial intention of scaffolding learning by offering different ways for students to engage with content is supported by recent research by Dong et al. [ 36 ] who found that students performed better academically in a flipped classroom. This point, in association with our findings, suggests that the best approach to content delivery for graduate entry nursing students is to ensure students are involved in curriculum and course design alongside the delivery of learning experiences that are well facilitated and supported by faculty so that students are aware of the expectations, required of them, and importantly how they will be assessed.
We acknowledge that the sample size in this study is small in terms of generalisability. However, our findings offer interesting, detailed and in-depth insights into the experiences and needs of both GEN students and the academic staff involved in the development and delivery of educational material. Further work needs to be undertaken to evaluate the experiences of GEN students from a range of educational providers. A longitudinal study has been undertaken to explore the motivations and experiences of GEN students in Australasia [ 37 ], which will also support these findings regarding the learning needs of GEN students.
This study has provided a platform through which academics and GEN students can share their insights of teaching and learning experiences. The results offer a clear insight into what these students expect and need to expedite their learning and how teaching staff must respond. While participants' views were somewhat mixed in relation to the use of unfolding case studies and scaffolded learning these results demonstrate how GEN students are aware of their personal ways of learning and how this translates in terms of education needs. The sharing of these experiences provides an insightful lens through which to re-evaluate pedagogical approaches for GEN students. As such, we suggest that to meet the needs of GEN student’s not only is a blended pedagogical approach appropriate but expanding education design boundaries further through a co-design focused approach to GEN programme design.
The datasets generated and analysed during the current study are not publicly available due privacy and ethical restrictions of the participants, but are available from the corresponding author on reasonable request.
Downey KM, Asselin ME. Accelerated master’s programs in nursing for non-nurses: An integrative review of students’ and faculty’s perceptions. J Prof Nurs. 2015;31(3):215–25. Available from: https://doi.org/10.1016/j.profnurs.2014.10.002 .
Pellico LH, Terrill E, White P, Rico J. Integrative review of graduate entry programs. J Nursg Educ. 2012;51(1):29–37. Available from: https://doi.org/10.3928/01484834-20111130-01 .
Article Google Scholar
Levett-Jones T, Hoffman K, Dempsey J, Jeong SYS, Noble D, Norton CA, et al. The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Educ Today. 2010;30(6):515–20.
Article PubMed Google Scholar
Smith SB, Kennedy S. Authentic teaching to promote active learning: Redesign of an online RN to BSN evidence-based practice nursing course. J Prof Nurs. 2020;36(2):56–61. Available from: https://doi.org/10.1016/j.profnurs.2019.07.005 .
Herrington J, Reeves TC, Oliver R. Authentic Learning Environments. In: Spector J, Merrill M, Elen J, Bishop M, editors. Handbook of Research on Educational Communications and Technology. New York: Springer; 2014. p. 401–12.
Chapter Google Scholar
Herrington J, Reeves TC, Oliver R. A guide to authentic e-learning. London and New York: Routledge; 2009.
Book Google Scholar
Merisier S, Larue C, Boyer L. How does questioning influence nursing students’ clinical reasoning in problem-based learning? A scoping review. Nurse Educ Today. 2018;65:108–15.
Spiers JA, Williams B, Gibson B, Kabotoff W, McIlwraith D, Sculley A, et al. Graduate nurses’ learning trajectories and experiences of problem-based learning: A focused ethnography study. Int J Nurs Stud. 2014;51(11):1462–71. Available from: https://doi.org/10.1016/j.ijnurstu.2014.03.002 .
Article CAS PubMed Google Scholar
Svensson J, Axén A, Andersson EK, Hjelm M. Nursing students’ experiences of what influences achievement of learning outcomes in a problem-based learning context: A qualitative descriptive study. Nurs Open. 2021;8(4):1863–9. Available from: https://doi.org/10.1002/nop2.842 .
Article PubMed PubMed Central Google Scholar
Martyn J, Terwijn R, Kek MYCA, Huijser H. Exploring the relationships between teaching, approaches to learning and critical thinking in a problem-based learning foundation nursing course. Nurse Educ Today. 2014;34(5):829–35. Available from: https://doi.org/10.1016/j.nedt.2013.04.023 .
Maddison C, Strang G. Do action learning sets facilitate collaborative, deliberative learning?: A focus group evaluation of Graduate Entry Pre-registration Nursing (GEN) students’ experience. Nurse Educ Pract. 2018;28:285–91. Available from: https://doi.org/10.1016/j.nepr.2017.10.023 .
Cangelosi PR. Voices of graduates from second-degree baccalaureate nursing programmes. J Prof Nurs. 2007;23(2):91–7.
McCormick MJ, de Slavy JR, Fuller B. Embracing technology: Using an unfolding case simulation to enhance nursing students’ learning about Parkinson Disease. J Neurosci Nurs. 2013;45(1):14–20. Available from: https://doi.org/10.1097/JNN.0b013e318275b220 .
Carter JT, Welch S. The effectiveness of unfolding case studies on ADN nursing students’ level of knowledge and critical thinking skills. Teach Learn Nurs. 2016;11:143–6. Available from: https://doi.org/10.1016/j.teln.2016.05.004 .
Carr KC. Using the unfolding case study in midwifery education. J Midwifery Womens Health. 2015;60:283–90. Available from: https://doi.org/10.1111/jmwh.12293 .
Yousey YK. The use of unfolding case studies: Innovation in online undergraduate nursing education. J Nurs EducPract. 2013;3(4):21–9. Available from: https://doi.org/10.5430/jnep.v3n4p21 .
McKenney S, Reeves T. Conducting Educational Design Research. 2nd ed. New York: Routledge; 2018. Available from: http://ebookcentral.proquest.com .
Macdiarmid R, Winnington R, Cochrane T, Merrick E. Using educational design research to develop authentic learning for graduate entry students in New Zealand. Nurse Educ Prac. 2021; 51(01) Available from: https://doi.org/10.1016/j.nepr.2021.102965
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
Parahoo K. Nursing Research: principles, process and issues. 3rd ed. London: Palgrave MacMillan; 2014.
Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Liamputtong P, editor. Handbook of Research Methods in Health Social Sciences. Singapore: Springer; 2019. p. 843–60.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Available from: https://doi.org/10.1191/1478088706qp063oa .
Edwards S. Reflecting differently. New dimensions: reflection-before-action and reflection-beyond-action. Int Prac Dev J. 2017;7(1):1–14. Available from: https://doi.org/10.19043/ipdj.71.002 .
Ferguson LM, Yonge O, Myrick F. Students’ involvement in faculty research: Ethical and methodological issues. Int J Qual Methods. 2004;3(4):56–8.
Coffman S, Iommi M, Morrow K. Scaffolding as active learning in nursing education. Teach Learn Nurs. 2023;18(1):232–7.
Bowman K. Use of online unfolding case studies to foster critical thinking. J Nurs Educ. 2017;56(11):701–2.
Gonslaz L, Nielsen A, Lasatar K. Developing students clinical reasoning skills: A faculty guide. J Nurse Educ. 2021;60(9):485–93. Available from: https://doi.org/10.3928/01484834-20210708-01 .
Hobbs J, Robinson C. Learning and Transfer Effects of an Unfolding Case Study in an Adult Health Nursing Course. Nurs Educ Perspect. 2022;43(1):47–8. Available from: https://doi.org/10.1097/01.NEP.0000000000000801 .
Ellis M, Hampton D, Makowski A, Falls C, Tovar E, Scott L, et al. Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students. J Am Assoc Nurse Pract. 2023;35(1):55–62. Available from: https://doi.org/10.1097/JXX.0000000000000806 .
Macdiarmid R, Turner R, Winnington R, McClunie-Trust P, Donaldson A, et al. What motivates people to commence a graduate entry nursing programme: a mixed method scoping review. BMC Nurs. 2021;20:47. Available from: https://doi.org/10.1186/s12912-021-00564-9 .
Winnington R, Shannon K, Turner R, Jarden R, McClunie-Trust P, Merrick E, Donaldson A, Macdiarmid R. Learning experiences of first year graduate entry nursing students in New Zealand and Australia: a qualitative case study. BMC Nurs. 2023;22:74. Available from: https://doi.org/10.1186/s12912-023-01233-9 .
D’Antonio P, Beal MW, Underwood PW, Ward FR, McKelvey M, Guthrie B, et al. Great expectations: points of congruencies and discrepancies between incoming accelerated second-degree nursing students and faculty. J Nurs Educ. 2010;49(12):713–7. Available from https://doi.org/10.3928/01484834-20100831-08 .
Boling EC, Hough M, Krinsky H, Saleem H, Stevens M. Cutting the distance in distance education: Perspective on what promotes positive online learning experiences. Int Higher Educ. 2012;15(2):118–26. Available from: https://doi.org/10.1016/j.iheduc.2011.11.006 .
Bovill C. Co-creation in learning and teaching: the case for a whole-class approach in higher education. High Educ. 2020;79:1023–37. https://doi.org/10.1007/s10734-019-00453-w .
Paige JB, Smith RO. Nurse faculty experiences in problem-based learning: An interpretive phenomenologic analysis. Nurs Educ Perspect. 2013;34(4):233–9.
PubMed Google Scholar
Dong Y, Yin H, Du S, Wang A. The effects of flipped classroom characterized by situational and collaborative learning in a community nursing course: A quasi-experimental design. Nurse Educ Today. 2021;105. Available from: https://doi.org/10.1016/j.nedt.2021.105037
Macdiarmid R, McClunie-Trust P, Shannon K, Winnington R, Donaldson A, Jarden R, et al. What Motivates People to Start a Graduate Entry Nursing Programme: An Interpretive Multi-Centred Case Study. SAGE Open Nursing. 2021;7. Available from: https://doi.org/10.1177/23779608211011310 .
Download references
Not applicable.
The corresponding author received funding from Faculty of Health and Environmental Science at AUT.
Authors and affiliations.
Department of Nursing, Faculty of Health and Environmental Science, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
Rachel Macdiarmid & Rhona Winnington
Nursing and Midwifery Directorate NSLHD, Royal North Shore Hospital, Level 7 Kolling Building, St Leonards, NSW, 2065, Australia
Eamon Merrick
Nursing Faculty of Health, University of Technology Sydney, Sydney, Australia
You can also search for this author in PubMed Google Scholar
RM*: Conceptualisation, methodology, investigation, formal analysis, writing original draft and review/editing. EM: Conceptualisation, methodology, investigation, formal analysis, writing original draft and review/editing. RW: Conceptualisation, methodology, investigation formal analysis, writing original draft and review/editing. The author(s) read and approved the final manuscript.
Correspondence to Rachel Macdiarmid .
Ethics approval and consent to participate.
Ethical approval and consent to participate was obtained from Auckland University of Technology Ethics Committee (19/233). All methods were carried out in accordance with relevant guidelines and policies as per the ethical approval obtained. The authors can confirm that informed consent was obtained from all subjects prior to interviews occurring. Consent was both written and verbal.
Competing interests.
The authors declare no competing interests.
Publisher's note.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Additional file 1., rights and permissions.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Reprints and permissions
Cite this article.
Macdiarmid, R., Merrick, E. & Winnington, R. Using unfolding case studies to develop critical thinking for Graduate Entry Nursing students: an educational design research study. BMC Nurs 23 , 399 (2024). https://doi.org/10.1186/s12912-024-02076-8
Download citation
Received : 06 December 2023
Accepted : 06 June 2024
Published : 11 June 2024
DOI : https://doi.org/10.1186/s12912-024-02076-8
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
ISSN: 1472-6955
COMMENTS
A Case Study about Child Development Lucas is almost four years old and lives with his mom and dad in a house in the country. His father is a train engineer and spends a few days a week on the rails while his mother stays at home as a housewife. Their house sits on a large plot of land surrounded by woods on one side and a cornfield on the other.
According to Manas (2019), Early Childhood Development is the term used to describe a child's physical, cognitive, linguistic, and socioemotional development from conception until age eight. This ...
Case Studies. Case studies involve exploring a single case or situation in great detail. Information may be gathered with the use of observation, interviews, testing, or other methods to uncover as much as possible about a person or situation. Case studies are helpful when investigating unusual situations such as brain trauma or children reared ...
The case studies across different age groups in early childhood education are a great resource, and the case-related and general questions allow leveling and individualizing for teacher development. — Karen La Paro, Professor and Codirector, Birth-Kindergarten Undergraduate Program, University of North Carolina-Greensboro
Professor Stetzel. May 5, 2008 Case Study: An In-depth Observation of Sam. Sam is a four-year-old male residing in the town of North Manchester, Indiana. He lives with his biological parents and sixteen month old sister, Lydia. According to. Sam, the dog, Jake, is also a member of the family. Sam's father, Brad, is a third grade.
JESSICA: A CHILD DEVELOPMENT CASE STUDY 5 straighten her teeth. Jessica also fractured her right wrist in the fifth grade, requiring her to wear a cast for about a month. At 10 years of age, Jessica weighed 55 pounds and was 46 inches in length. Jessica was diagnosed with Turner Syndrome at age 10, a chromosome disorder which
Table 2: Adapted from the CEPD 8102 Assignment 2: Child Case Study assignment description in the course syllabus Emotional Development The young child's growing awareness of self is linked to the ability to feel an expanding range of emotions. Young children, like adults, experience many emotions during the course of a day.
The case under study includes: demographic data of the family, anamnesis of the child (data obtained from psychological and medical research), prescribed therapy and progress, "The Time Line" (Stanton, 1992)—technique to retrieve significant events from the mother's history during the main stages of her development, located on the "axis ...
Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn. We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social ...
Advocacy paper: Advocacy document that summarizes what Care for Child Development (CCD) is, the evidence that supports the approach, and the main results of its implementation in Latin America and the Caribbean. Case studies: Five case studies that describe the experience of implementing the Care for Child Development approach in the policies ...
Write an in-depth Case Study of one of the children you observed in the previous assignment, a child between the ages of birth and 12 years old Explicit details for this case study are available online in eCollege: DocSharing: CaseStudy.pdf. Aligns with Student Learning Outcomes: D Your Case Study must respond directly to each of the following ...
According to Johnson (2012), reports of child maltreatment to the Connecticut Department of Child and Family Services have actually decreased in the schools where the program has been implemented "because [the ALIVE program is] catching problems well before they have risen to the severity that would require reporting" (p. 17). Case Example 1
Scaling up quality early childhood education in India by investing in ongoing professional development for officials at the state, district and local levels (India) Strengthening early childhood education in the national education plan and budget in Lesotho to help children succeed in primary and beyond (Lesotho)
Developmental Case Study. Articulate theories of growth, development and learning in all children ages 0-8 years, and demonstrate awareness of these theories as they impact children through adolescence. 7. Identify strategies supportive of the typical and atypical development and the learning patterns of each child and their family within the ...
This Child Observation Case Study will be based off National Association for the Education of Young Children (NAEYC) Standards including: Standard 1 (Child Development and Learning) - Beginning Early Childhood teachers are able to use their (1a) understanding of young children's characteristics and needs, (1b) and of multiple interacting ...
As active agents in their own development, children hold unique perspectives on various environmental issues (Lawson et al., 2018; Peterson et al., 2019; ... Data from these 12 case studies revealed that child-to-parent IGL was present in some but not all of the cases. Some children were attributed the role of decision-makers by parents but ...
This case study is on a young girl named Hannah. She was observed in a classroom at the Early Learning Center. She is 4 years old. She is the only child, and lives with her father and grandmother. Throughout the paper, it compares Hannah's development to what develop mentalist say is normal. The paper is focused primarily on
Developmental theorists use their research to generate philosophies on children's development. They organize and interpret data based on a scheme to develop their theory. A theory refers to a systematic statement of principles related to observed phenomena and their relationship to each other. A theory of child development looks at the children's growth and behavior and interprets it. It ...
The document describes a case study of a child's development during early childhood between ages 2-6. Researchers observed and interviewed a child and parent at a daycare center to learn about the child's experiences and development from their perspective. The case history provides background on the child, a 4-year-old boy, and details the ...
Lucas A Case Study about Child Development. nullnullnull. Allison Gallahan Child Development, Section B Professor Stetzel May 6, 2009. Abstract After an extended period watching and observing Lucas, the bystander is able to see where Lucas is developmentally. He is growing physically, mentally, and emotionally as a child his age, four years old ...
The study of patterns of growth, change, and stability that occur from conception through adolescence. Includes cognitive, physical, emotional, and social changes that occur as we develop. Topical approaches to child development. Physical: growth, movement, function, sleep, nutrition. Social and Emotional: Interactions with others and ...
This case study describes the development of a toddler named Tatum. The study is mainly going to take place at her house and her grandma's house. Tatum recently turned two years old on March 22. Her father's name is Pat and he works for a wireless internet company. He grew up in a household of 3 siblings and was the second oldest child.
This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient-provider relationships or clinical autonomy.
Background Graduate Entry Nursing (GEN) programmes have been introduced as another entry point to nurse registration. In the development of a new GEN programme, a problem-based approach to learning was used to develop critical thinking and clinical reasoning skills of motivated and academically capable students. Objective To explore and evaluate the design and delivery of course material ...
Child Development. Professor Stetzel. Year Old FemaleKayla, three year old female, was observed for this case study at North Manchest. rChurch of the Br. hren. Kayla resides with her mother, father, and three sisters, one of. which isan identical twin. Her family lives in a country home on a p. ductive dairy farm whi.