Domains of Learning
Consider the domains of learning when you frame your lifelong learning plan. The field of education has identified three such domains:
The cognitive domain: knowledge - facts, principles, research findings and other information you might learn from reading, listening to audiotapes or lectures, or watching and listening to audiovisual media.
The psychomotor domain: skills and actions - nursing procedures, computer skills and other activities you might learn from demonstration, corrective feedback and practice.
The affective domain: attitudes, feelings and values - cultural competence, communication and other emotion- and value-based learning. Learning in this domain usually is most effective with strategies such as role play and corrective feedback in practice.
To these classic domains, some have suggested adding a fourth domain, the social domain. In order of increasing complexity of behaviors, the social domain consists of communication, collaboration, managing and leading. Learning in the social domain blends components of learning in the three original domains and requires social interaction and practice for learning to occur.
Most nursing activities include some element from each domain. For example, documentation requires knowledge of what data is relevant and where to place it in the documentation system. Certain psychomotor skills are involved in entering information, whether in writing or data entry. Although nurses document objectively, documentation also reflects attitudes, feelings and values related to patients, patient care and the importance of documenting certain information. Documentation enters the social domain because one of its purposes is communication among members of the health team.
Another example of the interaction of the domains of learning can be found in delegating patient care. When delegating care to assistive personnel, the nurse observes certain rules (cognitive), makes assignments (psychomotor), and respects attitudes and values (affective). All of these elements combine in the social domain in which communication and collaboration make delegation succeed.
Nurses do not learn to delegate effectively if they only address one domain in the learning process. For example, knowledge of delegation rules, patient needs and staff members' competencies will not lead to effective delegation unless attitudes are considered and effective communication and collaboration approaches are practiced.
When constructing your lifelong learning plan, consider the domain that predominates in the learning you want to accomplish. Written material and audiovisual material are very effective for learning in the cognitive domain. However, psychomotor, affective and social learning require supervised practice with corrective feedback.
Budget the funds required to carry out your plan. Fully explore sources to assist you. Your nursing unit's budget may include limited funds to sponsor attendance at continuing education programs. Your facility may have a tuition reimbursement program. The staff education department may have scholarship funds.
Also, professional organizations may offer scholarships. Your school of nursing may have a scholarship program for alumni. Many courses online and published in nursing journals are available for nominal fees. For new grads, it's a good idea to take some money and start your own CE fund.
Formal Learning Opportunities
Four categories comprise formal learning opportunities.
Inservice Education Learning Activities: Your employer may provide educational activities to allow you to gain the competencies required in your job. Inservice education learning activities include annual mandatory safety-related topics, training on new equipment, and communication about new policies and procedures required for safe practice. Nursing units using many types of technology, such as the ICU, may have as many as five inservices per week to train nurses to use new equipment.
Inservice education may be presented as classes or self-studies in the form of print, posters or computer-based learning activities.
Give feedback to your manager or staff educator about inservice education activities. Let the appropriate person know how well the scheduling and format of these activities meet your needs.
Continuing Education Learning Activities: Your employer may provide educational activities for which you can earn continuing education contact hours.
Or you may need to seek accredited continuing education learning activities outside of your facility. Even if your facility provides accredited continuing education, you probably will need to explore other sources to fully meet your needs.
Specialty professional organizations present conferences and offer many educational activities in self-study formats. Visit the Web sites of professional organizations in your specialty to explore learning opportunities. Other Web sites offer a selection of topics in a variety of specialties. The staff education department at your facility receives numerous brochures publicizing conferences. Local and regional nursing organization newsletters and the careers section of some local newspapers also list continuing education opportunities.
Certifications: Your facility may offer certification programs. The American Nurses Credentialing Center offers certification in more than 40 nursing specialties. For information, visit www.nursingworld.org/ancc/certification/certs.html. Some nursing specialty organizations also offer certification - the CCRN certification offered by the American Association of Critical-Care Nurses, for example. Some nursing specialty organizations offer educational programs leading to certification in particular skills, such as the Association of Women's Health, Obstetric and Neonatal Nurses' fetal heart monitoring program.
Academic Degrees: Consider BSN degree completion if you do not already have your BSN. Research has identified that increased numbers of BSN-prepared nurses in the staffing mix is related to better patient outcomes.8 At its 2005 convention, the Association of Nurse Executives (AONE) supported the BSN as the educational preparation for nurses.
"The educational preparation of the nurse of the future should be at the baccalaureate level," said AONE President Marilyn Bowcutt, MSN, RN, in an April 2005 statement. "This educational preparation will prepare the nurse of the future to function as an equal partner, collaborator and manager of the complex patient care journey that is envisioned by AONE."9 Many facilities require the BSN degree for promotion; some facilities offer a pay differential.
Degree completion programs have become increasingly user-friendly in scheduling options. You can meet many of the requirements through online coursework.
Before pursuing an advanced degree, clarify your goals. Do you intend to prepare for advanced practice as a nurse practitioner, nurse anesthetist, clinical nurse specialist or nurse midwife? Do you intend to prepare yourself for a management role? For a faculty role? For a staff educator role?
Assess graduate programs carefully to determine how well a particular program will prepare you to meet your career goals. Increasingly, schools are developing distance learning options for graduate degree programs. Also, determine whether an academic degree is the best preparation for pursuit of your career goal. Perhaps a fellowship or other educational route would better suit your purposes.
Methods for Lifelong Learning
Formal lifelong learning opportunities are presented in one of four general formats.
Live Courses: Vary in length from an hour to 1 or more days. Some courses continue for a period of weeks. One contact hour is awarded for every 50 minutes of class time.
Professional Conferences and Conventions: Sponsored by professional organizations, continuing education providers, healthcare facilities, colleges, and universities. Usually, professional conferences and professional organization conventions continue over a period of 3 or more days. The conferences feature workshops, general session speakers and concurrent session speakers. Learning activities relate to a general theme. Some conferences offer different tracks and a series of concurrent sessions.
Self-Study Options: Offer the opportunity to read, view or listen to information and take a test to earn continuing education credit. Needless to say, there are many valuable journal articles, monographs and texts that do not offer continuing education contact hours. Some of the formats available include:
Professional reading materials
Publications of professional organizations
Videotapes and DVDs
Noninteractive and interactive CDs and DVDs
Online journal articles
Online publications of professional organizations
Non-interactive online for-credit courses
Online search engines to help you identify materials and courses of interest on a given topic
Interactive Web-Based Courses: Provide material to read, interactive activities and the opportunity to interact with fellow participants and an instructor in discussion forums.
Informal Learning Opportunities
In addition to formal learning opportunities, the practice arena offers rich informal learning opportunities.
First, interact with nursing and interdisciplinary colleagues. Experts in education for the health professions strongly recommend interdisciplinary interaction in the education process. And, accrediting organizations such as JCAHO emphasize interdisciplinary collaboration in patient care and quality improvement.
Some continuing education programs sponsored by the professional organizations of other disciplines also offer nursing continuing education credit. Investigate the offerings of other disciplines. Contact relevant departments in your facility.
Take a proactive approach toward learning from colleagues. The opportunity is both to learn and to teach. One nurse who had studied an online continuing education course about medication safety challenged a physician's order for certain medications via enteral feeding tube. The physician's response was, "Since when do you know that?" Speaking up about what you know fosters collaboration and respect. Don't hesitate to recommend or question orders based upon your knowledge.
Exercise your curiosity. Many colleagues in other disciplines use techniques and knowledge that can contribute to more efficient, effective care. For example, EMTs use a 60-minute clock method for IV drip rate calculation that efficiently replaces the formula many nurses use.
Advanced practice nurses and physicians often are very willing to coach nurses in specialized physical assessment skills. Physical therapists, respiratory therapists, pharmacists and all other members of the healthcare team can give nurses entrZe into the latest information in their fields - when asked.
Second, contribute to others' lifelong learning. The mandate for lifelong learning includes a professional responsibility to contribute to the professional development of other nurses. Research has documented prerequisites of clinical judgment for new nurses.10,11 A sense of connectedness with patients and other staff, and confidence in skill performance, form a necessary basis for judgment and critical thinking.
The preceptor plays a critical role in professional development. But, it takes a unit to raise a new nurse and all unit staff have roles to play: contribute to the sense of belonging, share tricks of the trade, coach in skills that are your special expertise. If you precept, seek learning opportunities to enhance your precepting skills. Share your precepting experiences and challenges with other preceptors. Mutual sharing will refine your skills and those of your preceptor colleagues.
Keep your curiosity alive. Seek opportunities to learn from your colleagues and share new learning with them. Many of the formal learning methods described in this course are solitary adventures, but only if you keep the knowledge to yourself. Contribute to a practice environment that features plenty of asking and sharing.
Excellence Along the Road
Lifelong learning, as its name proclaims, is a continuous process. Not only does new information become available constantly, but also new sources of information and methods of learning appear on the scene frequently.
Find inspiration in the words of a new graduate interviewed in a qualitative study of new graduate competencies: "I'm beginning to think that the road to excellence is a long one, but you can be excellent along the road."12