NUR 5223 Module 2 Adult Learning Application Paper Example

Six Hours of Instrument Names: Knowles's Six Assumptions Applied to a Failed Classroom Day in a Perioperative Fellowship, and the Redesign They Produced

Student Name

American College of Education

NUR5223: Theoretical Foundations in Teaching and Learning

Module 2 Assignment

Instructor Name

May 16, 2028

The Situation

In the second week of the perioperative fellowship introduced in Module 1, the eight fellows, all experienced registered nurses new to the operating room, spent a full day in a classroom learning surgical instruments. A sterile processing educator presented slides of about 150 instruments by name and category, followed by a written quiz. By mid-afternoon two fellows were answering email, one had left for an extended break, and the quiz average was 64%. In the day's evaluation, fellows wrote that the content was important but the day was exhausting and that they could not see how they would use most of it. The following week, in their first cases, several could not find the instruments the scrub person asked for, although they had seen every one on a slide.

The day was not poorly prepared, and the content matters: a circulator who cannot recognize an instrument cannot anticipate a need or reconcile a count. The problem lay in how the day treated its learners.

Knowles's Six Assumptions

Knowles et al. (2015) set out six assumptions about adult learners that distinguish andragogy from traditional teacher-directed models. Adults want a reason for learning something before they commit effort to it. They have a self-concept as responsible for their own decisions and resent situations in which others impose their will. They bring a large and varied store of experience, which is a resource for learning and also a source of habits and biases. They become ready to learn what they need to cope with real-life situations. Their orientation to learning is centered on problems and tasks rather than on subjects. And while they respond to external motivators, the most potent motivators are internal, such as job satisfaction, self-esteem and quality of life.

Applying Each Assumption

Need to know. The day began with instrument categories and never explained why a circulator needs to recognize instruments, what goes wrong when one does not, or how the knowledge will be used. A single story of a count discrepancy caused by an unrecognized instrument would have answered the question every fellow was silently asking.

Self-concept. The fellows are accustomed to directing their own work. A day in which they sat and listened, with no choices about pace or focus, cast them as students in a way that clashed with how they see themselves, which may explain the email and the extended break.

Experience. The fellows already know anatomy, surgical procedures from the other side of the doors and many instruments by function from bedside procedures. The lecture did not use any of it. Experience also cuts the other way: nurses from intensive care units bring habits of clean rather than sterile technique that must be unlearned, a point that belongs later in this paper.

Readiness. The fellows were ready to learn the instruments for the cases they were about to circulate, not all 150 at once. Readiness arrives with the task.

Orientation. Organizing instruments by category, clamps, retractors, scissors, is subject-centered. The fellows would learn them in the context of procedures: the tray for a laparoscopic cholecystectomy, the tray for a total knee.

Motivation. The fellows' strongest motivation is not the quiz but their wish to be competent and respected in a new role. A design that let them feel capable in a real case by Thursday would do more for learning than any grade on Tuesday.

The Redesign

The redesigned instrumentation learning replaces the single day with a sequence tied to the fellows' case assignments. Before their first week of cases, fellows receive the instrument trays for the three procedures they will circulate most often, as photographs with names and functions, and a short account of a count error from the hospital's own event reports. In a two-hour skills laboratory session, they open real trays in pairs, identify and handle each instrument and explain to each other what it is used for in the procedure, drawing on what they already know. Each week thereafter, they learn the trays for their next week's cases, and in the weekly reflection seminar they bring any instrument they could not identify in a case and teach it to the group. Assessment moves from a written quiz on 150 slides to a practical check: identifying and naming every instrument on a tray before circulating that procedure independently.

The redesign also changes when the learning happens, and that change has support beyond andragogy. The original day was massed practice: 150 new items in one sitting. A large quantitative synthesis of studies on verbal recall found that spreading study sessions over time, rather than concentrating them, produced better long-term retention across a wide range of intervals and tasks (Cepeda et al., 2006). Learning a few trays each week, revisiting them in cases and again in the seminar, spaces the practice in exactly this way. For content like instrument names, which must be recalled quickly under pressure months later, spacing is likely to matter as much as relevance.

Each change maps to an assumption. The count story answers the need to know. Choice of pace and peer teaching respect self-concept. Handling instruments and explaining their function draws on experience. Learning trays just before the cases that use them matches readiness. Organizing by procedure matches problem orientation. And early competence in real cases feeds internal motivation.

Where Andragogy Needs Care

Andragogy has been criticized, and the critique matters here. Merriam (2001) notes that andragogy has been described more as a set of assumptions about good practice with adults than as a theory, that its assumptions describe some adults better than others, and that it gives little attention to the social and institutional context in which learning happens. Three cautions follow for the fellowship. First, self-direction has limits in a high-risk setting: aseptic technique and surgical counts must be learned to a fixed standard, and fellows cannot choose to skip the drill because they feel competent. The redesign keeps those drills mandatory. Second, experience can mislead. The fellows from intensive care units were the most confident about technique and made the most breaks in sterile technique in the skills laboratory, because their habits were strong and slightly wrong. Learning for them means unlearning, which requires explicit comparison between the old habit and the new standard, not just drawing on experience. Third, the operating room's culture shapes learning as much as the fellows' characteristics do; a fellow who is ready and motivated will still struggle if staff treat questions as a nuisance. The fellowship therefore works with the operating room's charge nurses to make questions expected, a theme Module 3 takes up.

Evaluating the Redesign

The redesign will be evaluated with the next cohort by three measures: the proportion of fellows who pass the practical tray check on their first attempt for each procedure, the number of times in their first month that a fellow cannot locate an instrument requested during a case, as recorded by preceptors, and fellows' ratings of the relevance and usefulness of instrumentation learning. The results will be compared with this cohort's quiz scores and preceptor reports.

References

Cepeda, N. J., Pashler, H., Vul, E., Wixted, J. T., & Rohrer, D. (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354-380. https://doi.org/10.1037/0033-2909.132.3.354

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Merriam, S. B. (2001). Andragogy and self-directed learning: Pillars of adult learning theory. New Directions for Adult and Continuing Education, 2001(89), 3-14. https://doi.org/10.1002/ace.3