AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

PROGRAM DESIGN FOR ADULT LEARNERSAudrey C. Martins, PhD, RN

Associate Professor, School ofNursing,Curtin University of Technology, Perth, Western Australia

The voice of adult learners is often overlooked in thedesign ofprograms that are specifically constructed tomeet their learning needs. This article portrays thedesign of a midwifery re-registration program thatcommenced with a survey ofnon-practising midwives.The organisation of the course, together with theprocesses involved in curriculum building areexplained. Theadult learner,particularly in a situationwhere previous knowledge, skills and experience arevital inputs to the design of programs, have beenhighlighted.

Program designed for adult learners1\\'0 main factors influenced the development of are-registration midwifery program based onKnowles (1975) concepts of adult learning. Theprogram was designed and implemented at StjohnofGod Hospital in WesternAustralia. First, the voiceof adult learner that was encountered during asurvey to establish whether a need existed for asecond re-registration program in the State(one wasalready in operation at a public hospital in Perth)wasconsidered. Expressed views conveyed the.draw­backs of traditional re-entry programs. Theseincluded predetermined fixed learning experiencesthat allowed minimal consideration ofadult learnerdifferences. Second, the requirement ofattendanceat the school for the entire program wasconsideredunnecessary. Instead, an alternative of someelements conducted on an external or distanceeducation mode was expressed. The mandatoryattendance requirement was seen to particularlydisadvantage nurses in rural communities, who hadthe additional expense of travel to the metropolitanarea, as wellas the payment of board and lodging forthe duration of the course. These two factorscoupled with sufficient demand for a second re­registration midwifery course became the catalystfor a program designed for adult ICarners.

Course developmentDevising a curriculum is a very special province ofthe teaching faculty if they are to develop a sense ofcurriculum ownership (Scales1985: 2). Hence, plan­ning, conferring and curriculum writing began by

establishingan advisory committee about 18monthsbefore the course was offered. The advisory com­mittee consisted of a nursing curriculum consultant,an obstetrician, a neonatal paediatrician and threenurse educators from the Stjohn of God MidwiferySchool ofNursing. Practitioners from various clinicalareas like labour ward, antenatal and home births,together with other allied health professionals, wereco-opted onto the committee as needed.

The advisory committee met weekly during theearly stages of course planning, followed later byregular but less frequent meetings. In the beginning,questions were explored in relation to employment,the need and choice of clinical experience in thecourse, organisation ofcourse content, and whetherthe course should emphasise new procedures,problems and treatments in midwifery practice, orshould course content be a review and update ofknowledge and skillsto safely practice as a midwife.In all the deliberation, a converging focus centred onclinical competence and related adult learner issuesemerged. These were:

• What teaching strategies utilising previous know­ledge and skills of the re-entering learner bestdevelops clinical problem-solvlng skills.

• How to structure content to update reproductivebiology and related sciences apart from didacticteaching/learning.

• How to correlate and find a balance betweenclassroom and clinical practice, to facilitateconfidence of the adult learner returning topractice.

• What influences in the nursing laboratory andclinical practice (e.g.number of hours, selection ofsettings and preceptors and learner/preceptorratios)are associated with the levelof performancefor the re-entry midwife.

• How to evaluate learning outcomes in order torecommend re-registration as a midwife to theNurses Board of Western Australia.

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AUSTRALIAN COLLEGE OF MIDWlVES INCORPORATED

One way to develop a course based on thesequestions was to construct a conceptual frameworkto guide the process, and promote what Ausubel(1968) considers as 'meaningful learning'.

Conceptual frameworkAconceptual framework embodying a paradigm ofthe learner, the Outcomes oflearningand the processof learning allowed a conceptualisation of thephilosophy underpinning the course as a whole(White 1983: 28) . It helped to guide the curriculumimplicitly by that which was deemed to be ofvaluein the educational endeavour.

Curriculum conceptual framework

ADULT LEARNER LEARNER'S OUTCOME• Experience • Desired behaviours• Knowledge needed for safe• Skills midwifery practice• Attitude

LEARNING PROCESS• Participatoryadult

learning strategies• Facilitating learning

Outcomes• Reflective practicum

PhilosophyThe philosophy ofthe Stjohn of God teaching staffwas that:

• the non-practising midwife would naturally haveanxieties about knowledge and skills needed formodern midwifery practice.

• returning midwives are adult learners and as suchrequire self-directed teaching strategies compat­ible with life'sexperiences, problem-solving skillsand ability for self-directed study.

Course structureBased on these beliefs, a course of about 80 hoursschool based learning integrated with 80 hours ofpracticurn, was designed. The aim was to review,reawaken and build upon existing knowledge, skillsand attitudes, to maintain motivation and to fosterthe joy oflearning. The practicum ofthe course wasdeveloped on what Schon (1987) calls 'reflectivepractice' which aimed at capitalising on the artistryofadult learners. Artistry was seen in terms of the actofproblem framing, planning, implementation and

improvisation needed to assist learners tocompetence in the indeterminate zone of practice.

The ultimate aim of the re-registration course was toprepare the returning midwife to be competent topractice midwifery, The process of performanceexamination, therefore, became an importantconsideration of program design. Carefully con­structed and consistently administered examina­tions, as advocated by Lenburg (1979) set thestandards for performance evaluation and served asa guide to learning those competencies expected bythe Nurses Board of Western Australia (1990) .

Foundations for the course consisted ofan externalpackage of Reproductive Biology and RelatedSciences. It was intended that learners would workat their own pace and be admitted to the coursewhen they were ready and had completed theaccompanying work assessment of the studypackage.

In addition to Foundation Studies and Practicurn,two other areas of the course, Nursing Studies andNursing Skills were developed (see curriculummodel). The former consisted of the essentialcognitive learning related to the theory ofmidwiferypractice. For this unit, students with the assistance ofthe midwifery teachers would develop a syllabusbased on the learning needs of that particular intakeof students. The content of Nursing Studies, there­fore, could vary from group to group. The emphasiswas on using a flexible approach to meet learningneeds. The process of teaching suggested a varietyof teaching models that could be best suited for agroup of adult learners aoyce and Weil 1987). Thereturning midwife often lacks confidence in nursingskills that are new as well as those that were oncewell developed. To meet this learning need, well ­equipped instruction manuals, charts, skeletal andother models and audiovisual material on the variousprocedures was made available for students to re­develop their psychomotor skills in a controlled,non-threatening environment. The competencies ofthe Nurses Board ofWestern Australia for Midwiferypractice was a reminder of the mastery of learningrequired for registration as a midwife. Assistancefrom teachers was available when needed and per­formance validated when requested as adult learnerresponsibility was inherent in the course design .

SEPTEMBER 1992ACMI JOURNAL PAGE2';

AUSTRALIAN COLLEGEOF MIDWIVES INCORPORATED

UNIT

CURRICULUM MODEL

The following curriculum model reflects the variouscomponents of the re-registration midwiferyprogram:

Access to the course• Midwives who had not practised for five years or

more and who wished to be eligible to re-registerwith the Nurses Board of Western Australia.

• Midwives from other parts of the world who didnot meet the requirements of the Nurses Board ofWestern Australia and who wished to register assuch.

NursesUSA

ReferencesAusubel, D.P. Education Psychology: A Cognitive View. New

York. Holt , Rinehart & Winston, 1968.

Joyce, B.and Wil, M. Models of Teaching (3rd Edn) . New Jersey.Prentice Hall, 1987.

Knowles, M.Self-directed Learning: A Guide for Learners andTeachers. New York. Association Press , 1975.

Lenberg, C.B. Tbe Clinical Performance Examination. NewYork. Prentice Hall, 1979, p35-64.

Scales, F.S. Nursing Curriculum: Development, Structure,Function. Norwalk. Appleton-Century Crofts, 1985, p2.

Schon, D.A. Educating tbe Reflective Practitioner: 'Ibtoard aNew Design for Teachingand Learning in tbe Professions.San Francisco. jossey-Bass, 1987.

Standards of Midwifery Practice. Nurses Board of WesternAustralia , 1990 .

White, M.B. (ed) Curriculum Development from a NursingModel. New York. Springer Publishing Co., 1983, p28.

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ConclusionThe guiding principle throughout course develop­ment was that learning is facilitatedin an atmospherein which people are encouraged to trust in them­selves as well as in external sources. The aim was toassist the learner to become less dependent uponauthority so that they feel that they are a valuableresource for learning. It was important that thecourse offered would make the returning midwivesfeel that they had something to bring to the learningSituation, rather than viewing learning as the acquisi­tion of facts and knowledge from some externalagent for use some time in the future. Thecurriculum builders strongly believed that adultslearn best when they begin to see themselves as thewellsprings of ideas and when learner abilities andlimitations are considered in a supportive milieu thatincreases their self-esteem.

CLINICALPRACTICE

PAGE 26 ACMIJOURNAL SEPTEMBER 1992