NUR 5223 Module 1 Learning Theory Comparison Example

Experts Again Beginners: Behaviorism, Cognitivism and Constructivism Compared for Experienced Nurses Learning the Circulating Role in a Perioperative Fellowship

Student Name

American College of Education

NUR5223: Theoretical Foundations in Teaching and Learning

Module 1 Assignment

Instructor Name

May 9, 2028

The Learners and What They Must Learn

The learners are eight registered nurses in a six-month perioperative fellowship at a composite 400-bed hospital, where the author coordinates the fellowship. Each has between two and twelve years of experience, most on medical-surgical or intensive care units, and each has chosen to move into the operating room because of a staffing shortage that has left the department relying on travel nurses. They are competent, confident professionals in their own fields, and they are new to almost everything in the circulating role: maintaining sterile fields they do not scrub into, managing counts of sponges, sharps and instruments, positioning anesthetized patients, anticipating the surgeon's next need, documenting in real time and speaking up when something is wrong in a room where the hierarchy is steep and the pace is fast.

Benner (1982), drawing on the Dreyfus brothers' account of how skill develops and testing it against the practice of nurses, observed that experienced nurses who move into an unfamiliar clinical area may function at a lower level of competence there, because expertise is tied to familiar situations and does not transfer automatically. The fellows illustrate that observation. In the first two weeks, several described feeling like new graduates again, and two said privately that they were considering returning to their old units. The learning theory chosen for the fellowship must therefore account both for what these nurses already know and for how disorienting it is to be a beginner again.

Three Theories

Ertmer and Newby (1993), comparing the three major learning perspectives from an instructional design point of view, describe how each defines learning and what each implies for teaching. Behaviorism defines learning as a change in observable behavior produced by the association between a stimulus and a response, strengthened by reinforcement. The teacher specifies target behaviors, arranges practice, provides cues and reinforces correct performance. Learning is judged by whether the behavior occurs reliably.

Cognitivism defines learning as a change in the learner's mental structures, the way knowledge is organized, stored and retrieved. The teacher's task is to help learners build and connect those structures, for example by organizing content, relating new information to what learners already know, and reducing the load on working memory through chunking, worked examples and job aids. Learning is judged by whether learners can use knowledge to solve problems.

Constructivism holds that learners build meaning from experience, and that knowledge cannot be separated from the situations in which it is used. The teacher designs authentic tasks, supports learners as they work within them and encourages them to reflect on and discuss their interpretations with others. Learning is judged by whether learners can act effectively in real, complex situations. Ertmer and Newby argue that the three perspectives suit different kinds of learning tasks and different stages of learner expertise, with behaviorist approaches best for basic, well-defined tasks, cognitivist approaches for structured problem solving, and constructivist approaches for complex, ill-structured problems among learners with more knowledge.

The Theories Applied to the Fellowship

Each theory would lead the fellowship coordinator to a different design. A behaviorist fellowship would break the circulating role into discrete behaviors, such as performing a surgical count in the correct sequence, opening a sterile package without contaminating it and positioning a patient for a lateral procedure, and would drill each with feedback until performance was reliable. That approach suits the counts and aseptic technique well, because they are procedures with right and wrong ways and little room for interpretation.

A cognitivist fellowship would focus on helping the fellows build mental models of how a surgical case unfolds: the phases from room preparation to transfer out, what the surgical team will need at each phase and how their prior knowledge of anatomy, pharmacology and patient safety connects to each. It would use case flow diagrams, procedure cards and worked examples, and would begin with simpler cases to limit cognitive load. That approach suits the anticipation that distinguishes a strong circulator.

A constructivist fellowship would place the fellows in real cases early, with a preceptor, and build learning around the problems those cases present, followed by reflection and discussion with other fellows and experienced circulators. It would treat the operating room's culture, its hierarchy and unwritten rules, as part of what must be learned. That approach suits the most complex part of the role: judging when and how to speak up, handling a count discrepancy under time pressure and reading a room.

The Choice and Its Reasons

The fellowship will use a constructivist approach as its core, with cognitivist supports and a limited behaviorist component for procedures that must be performed identically every time. Three reasons support this. First, the learners are experienced adults with extensive knowledge that constructivist learning can connect to; treating them as blank slates would waste their expertise and deepen the loss of confidence Benner describes. Second, the parts of the role that most affect patient safety and retention, speaking up and managing the unexpected, are ill-structured problems of the kind Ertmer and Newby associate with constructivist approaches. Third, the fellows' anxiety about being beginners again is itself a learning problem. Bandura (1977) identified mastery experiences, successfully performing a task, as the most powerful source of self-efficacy, the belief that one can succeed, and real cases with support provide mastery experiences that simulation and lectures alone cannot. The fellows did not need to be taught to be nurses; they needed to rebuild, inside a new room, the confidence and judgment they already had outside it.

Decisions the Choice Changes

The choice changes five concrete decisions. Fellows will enter real cases in the first week, circulating alongside a preceptor on straightforward procedures, rather than spending a month in the classroom first. Each week will end with a two-hour reflection seminar in which fellows bring a problem from their cases, such as a count that did not reconcile or a moment they hesitated to speak, and work through it together with an experienced circulator. Case flow diagrams and procedure cards will be provided as cognitive supports for each service line, withdrawn gradually as fellows no longer need them. Surgical counts and aseptic technique will be drilled in the skills laboratory to a set standard before fellows perform them independently, because these are the behaviors where variation causes harm. Finally, assessment will shift from written tests toward observed performance in real cases, rated against a behavioral checklist and discussed with the fellow afterward.

The design will be judged by three outcomes: the fellows' confidence in the circulating role, measured with a short self-efficacy scale at weeks two, eight and twenty-four; preceptor ratings of independent performance at six months; and retention in the operating room at one year, which is the hospital's reason for creating the fellowship. A fellowship that produces confident circulators who leave within a year would have failed at its purpose, however well its learners performed on checklists.

References

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. https://doi.org/10.2307/3462928

Ertmer, P. A., & Newby, T. J. (1993). Behaviorism, cognitivism, constructivism: Comparing critical features from an instructional design perspective. Performance Improvement Quarterly, 6(4), 50-72. https://doi.org/10.1111/j.1937-8327.1993.tb00605.x