A Grounded Theory of Conceptual Understanding

Purpose:

Rapid advances in technology and scientific knowledge compel nurse educators to continually add content to the curriculum.  There has been an increased emphasis on conceptual learning in the nursing curriculum as nurse educators realize that a content focused approach can no longer keep up with the advances in medical and nursing science.  Although the concept of conceptual understanding has been more fully developed in the mathematics and science education literature there has been an increased focus on conceptual learning in nursing education.  The application of the mathematics and science education literature connected well with the teaching and learning of medication dosage calculations in nursing education. The purpose of this study was to identify the process of undergraduate nursing students’ attainment of conceptual understanding when learning medication dosage calculations.  This is an important endeavor as nurse educators strive to understand how students learn in a course utilizing a conceptual approach.   The identification of conditions that support conceptual understanding in the classroom offers an awareness of teaching strategies that provide students with opportunities to gain conceptual understanding.  A blended theoretical framework of constructivism and symbolic interaction strengthened this grounded theory study.  This study presents an outline of the process of the attainment of conceptual understanding in undergraduate nursing students learning medication dosage calculations.  Analyzing the teaching and learning praxis that influences conceptual understanding provides evidence that can inform nursing education practices.  

Methods:

The study of conceptual understanding, an abstract phenomenon, was consistent with a qualitative research design.  The goal of the study was to discover the process by which a student attains conceptual understanding.  A grounded theory approach supported the discovery of a process oriented concept.  In addition, both conceptual understanding and grounded theory are reinforced by the underpinning philosophies of constructivism and symbolic interaction.   The purposive sampling process was limited to students in an undergraduate medication calculations course during the spring semester of their sophomore year at a Mid-Atlantic university.   Data were collected through seven classroom observations and 19 semi-structured interviews with 11 participants.  The researcher recorded field notes of student and faculty actions and interactions during the classroom observations.  The observations were coded using line by line coding and analyzed using constant comparative analysis throughout the data collection process.  Additionally, semi-structured interviews with students focused on trends identified during the observations.  Students were asked to describe their approach to studying and problem solving.  They were also asked to discuss the effectiveness of teaching strategies that were used during class.  Students were invited to be interviewed twice during the semester.  This allowed the researcher to evaluate conceptual understanding as the course content became more complex.  Eight of the eleven students were interviewed twice.   Line by line coding and constant comparative analysis was employed in the interview data analysis.  Saturation of data was reached making it possible to delineate the process of conceptual understanding. 

Results:

A process of conceptual understanding emerged from the data collected during classroom observations and student interviews.  The process began with the teaching and learning experiences in the classroom.  Questioning was the most common category noted in the classroom observations.  Course faculty utilized questioning to help students think critically and provided several problem solving opportunities with practice questions throughout the class.  Students also engaged in questioning of the faculty and each other as they participated in group problem solving activities.  The next phase of the process of conceptual understanding required that the students reengaged with the course content outside of the classroom.  This was typically done when the students practiced problems in the form of homework.  It was during this process of reengagement that the students realized that they were confused.  A majority of the participants reported that they understood the material in class but when they went home and practiced the problems they were “lost”.  Confusion was the core category of the process, indicating all of the students in the study were confused about the course content at one point.  Students who were able to work through the confusion and solve the problems were able to attain conceptual understanding and progress to more complex problem solving.  The identified process of conceptual understanding was iterative and cumulative with students cycling through the process several times during the course of learning and building on their previous understanding. 

Conclusion:

Faculty and students share a responsibility in the development of conceptual understanding.  The development of conceptual understanding was a process that began with the utilization of judicious and thoughtful questioning and the promotion of teaching strategies that encourage cognitive effort.  Providing students with opportunities to independently reengage with the content and identify areas of confusion was critical to the development of understanding.  Required meaningful learning assignments with grade implications that held enough weight to motivate students were necessary.   An important implication of this study was that students and faculty need to learn to be comfortable with confusion and the resulting critical thinking required for the attainment of conceptual understanding.  Confusion is an uncomfortable and often overlooked opportunity for learning to occur.  Scaffolding learning opportunities so that students are able to build on their understanding of concepts was also important.  Students who were able to gain conceptual understanding of the course concepts were able to build on that understanding and solve increasingly complex problems.  In the study exemplar this meant that students were able to move from understanding volume/dose problems to intravenous calculations.  Although the exemplar for the study was teaching and learning in a medication calculation course the process of conceptual understanding could be applied to other courses in the nursing curriculum.  The pedagogical implications of this study support the use of meaningful learning and questioning strategies in teaching undergraduate nursing students, providing students with opportunities to become comfortable with working through confusion, and increasing the complexity of problem solving throughout the curriculum.  As a substantive grounded theory of the process of conceptual understanding in teaching undergraduate nursing students’ medication calculations, this study adds to the science of nursing education and could be transferable to other aspects of the curriculum.