Currently, the nursing literature highlights varied interpretations of the learning process, with limited descriptions of how new and experienced nurses facilitate learning in practice; it also suggests that nurses are under-prepared. Kaufman et al. (2013) identified that health professionals lack understanding of how people gain knowledge and understanding in educational interventions, re-igniting an issue that La Duke (2000) had suggested was caused by nurses being unable to codify the cognitive, interpersonal aspects of care, although there was explicit, common language describing their technical, clinical tasks. This issue has not been explored, with a paucity of descriptions of ‘how’ nurses facilitate cognitive learning in their practice. Further, no common language is apparent to help nurses articulate the higher-level cognitive aspects of their practice. This scoping review served to address this knowledge gap.
Methods: This review, conducted between March 2017 and June 2017, used Arksey and O’Malley’s framework (2005), and focussed on English language literature, published between 1998-2017. Embase, MEDLINE, Pubmed, Informit, CINAHL, The Cochrane Library, Scopus, Joanna Briggs Institute, Psych-Info and ERIC were searched. Grey literature and the reference lists of the selected articles were also hand-searched to locate additional references. As this was a scoping review, the quality of the studies was not formally assessed. A second reviewer (ML) used the liberal accelerated approach (Khangura et al. 2012) to review 10% of included and excluded abstracts. This affirmed the principal author’s (DT) selections; where there were disagreements, these were discussed until consensus was reached. If consensus was not reached the principal supervisor (EM) adjudicated. Marzano et al.’s (1997) Dimensions of Learning framework provided an innovative ‘lens’, to guide the exploration of how clinicians facilitate cognitive aspects of learning and provide a ‘language’ to articulate the findings.
Results: The search identified 2,692 papers. Following removal of duplicates and papers not meeting the inclusion criteria, 89 were suitable for review. The studies originated in 12 countries, used a diverse range of methodological characteristics, covered a wide range of health conditions and parent-education situations. The health professionals involved were predominantly nurses (n=51: 57.3%). Less than half (34/89, 38%) of the studies showed evidence that nurses and health professionals were cognisant of all five Dimensions of Learning concepts, albeit, only implicitly. There were varied interpretations of how parents learn and little recognition of the significance of helping parents develop higher-level thinking skills, such as problem-solving and decision-making. No consistent meaning of the term ‘learning principles’ was identified, although the adult learning construct was termed ‘principles’ and perceived as the learning process in 13/89 (14.6%) of studies. Studies that combined adult learning principles with at least one other theoretical construct, 8/89 (10.1%) demonstrated successful learning outcomes. Thematic analysis revealed four overarching themes: divergent conceptualisations of learning; divergent learning expectations; barriers and enablers to learning and limited evaluation of learning. Health literacy, learning styles and learning needs were commonly perceived as constituting the cognitive learning process. However, the studies did not include evidence of nurses or health professionals facilitating parent skill development in analysis, problem-solving and decision-making, which parents need to be able to apply knowledge meaningfully and on an ongoing basis. In these studies, parents often reported their needs were not met. Assessment of clinical outcome measures was perceived as 'demonstrating effective parent learning’ in the quantitative and mixed methods papers. In contrast, the qualitative studies demonstrating that parents had become effective problem-solvers had evaluated parent learning, understanding and skill development by seeing parents successfully undertake treatments or tasks repeatedly and having parents answer scenario-based questions.
Conclusion: A significant re-think is needed in the way nurses and health professionals are prepared to deliver effective parent-education practice. Indeed, there is a need to explore how nurses and health professionals use learning principles in practice to identify whether a ‘language’ exists to codify practice. Such an evaluation has implications for nursing practice by providing a crucial step towards a more complete understanding of the cognitive aspects of parent-education. Once identified, appropriate, innovative educational programs can be created to support nurses and health professionals in applying learning principles to parent-education practice.