Learing and Teaching Styles of Student Nurse

18 Journal of Nursing and Health Sciences Vol. 9 (Special Issue) January-April 2015

Abstract

Background

A recent study recommended a great need for research on learning styles of student nurses. Moreover,

related literature has not been found exploring both the learning and teaching style of student nurses.

Aims

The study aimed to determine the learning and teaching styles of student nurses and if there is

an association between them. It also intended to discover whether student nurses are uni modal or

multimodal in their styles and identified their preferred faculty teaching style.

Methods

Quantitative Descriptive-Co relational design was used. There were 312 participants from School

of Nursing X, Baguio City, Philippines. The questionnaire utilized an adopted version of Fleming’s VARK

learning style version 7.2 (Visual, Auditory, Reader/Writer, Kinaesthetic) and Grasha’s teaching styles

(Formal Authority, Demonstrator, Facilitator, Delegator). Statistical package was used for

statistical treatment of data, where Chi-square was used for the correlation of uni model learning

and teaching styles.

Research Article

Learing and Teaching Styles of Student Nurse

Jefferson S. Galanza* Jewel An Mischelle R Camcam*

Alyssa Karryl C. Co* Stephanie P. De Guzman*

Kojin Q. Domingo* Jet Jet K. Dongui-is*

Rodolfo Dane C. Frias* Ovelle C. Jueco*

Harvey L. Matbagan* Victoria Luzette T. Rillon*

Christelle Romyna H. Saruca* Jeanette Roma M. Villasper*

* Saint Louis University, School of Nursing, Baguio City, Philippines 2600

Corresponding Author: Jetterson S. Jefferson S. Galanza email: [email protected]

19Journal of Nursing and Health Sciences Vol. 9 (Special Issue) January-April 2015

Results

Majority of student nurses’ learning style is Kinesthetic (47%) and their teaching style is

Demonstrator, which was also found to be associated at 5% level of significance. Students are Uni modal

in their learning (80%) and teaching (69%) modalities. In general, their preferred faculty teaching style is

similar to their teaching style.

Conclusion

Student nurses’ learning styles and teaching styles are varied, which exemplifies the uniqueness of

every learner and the contemporary nurse.This diversity in styles, when understood, can translate into

appropriate learning environment for the faculty and students to increase learning outcome and academic

achievement. For the faculty to conduct assessment of learning style at the onset of classes/clinical

placements and to develop a more valid tool.

Keywords: Learning, Teaching, Student Nurse

Introduction

How we see learning can affect how we teach

so before we explore how to teach, we explore how

people learn (Reece & Walker, 2002). Being a teacher

is one of the roles and function of a nurse. It is where

the nurse helps clients learn about their health and

the health care procedures they need to perform to

restore or maintain their health. The nurse assesses the

client’s learning needs and readiness to learn, sets

specific learning goals in conjunction with the client,

enacts teaching strategies and measures learning.

The teaching-learning process is far more complicated

than it seems, because there are a lot of factors that can

affect the outcome. Teachers and students in the real

world come in all forms and dimensions with wide

range of different personalities, beliefs and ways of

thinking, thus, this research somehow tried to

understand the roles being played by student nurses in

the learning and teaching process.

Learning is a dynamic process; it is the product

of student and teacher activity within a learning

environment (Bankert & Kozel, 2005). Learning is

often planned, for example, attending a course or

reading a book. It can also take place through

experience which is at times unexpected (Hand, 2006).

Such transformed experiences resulted in doing things

differently. Therefore, when learning has taken place,

it should be noted through some observational changes.

Learning style refers to the way students concentrate

on, process, internalize and recall new and difficult

information (Rochford, 2003). It plays an important

role in determining the levels of academic achievement,

students’ performance and interaction between

students and the teacher (Khurshid, 2012). Kazu, (2009)

also reiterated that it is very important for an individual

to know their learning style because it is one of the

most significant issues in becoming effective in the

process of teaching and learning and just merely

recognizing the learning styles of students contributes

to effectiveness. Finally, Ozkan, & Ulutas, (2012) states

that learning styles are defined as the various


approaches or ways of learning. It is known that

teachers should assess the learning styles of their

students and adapt their classroom methods to best fit

each student’s learning style.

Amidst numerous studies conducted on learning

styles of student nurses and general students from a

variety of courses and levels, a recent study conducted

by Bostrom and Hallin (2013) recommended a great

need for research on learning styles of student nurses.

Moreover, related literature has not been found

exploring both the learning and teaching styles of

nursing students and their preferred teaching styles

for their faculty. Dunn, Beaudry, & Klavas (1995)

posits that a number of studies conducted during the

last decade have found that students’ achievement

increases when teaching methods match their learning

styles, this statement was also supported by Lovelace

(2005), that in order to attain academic achievement or

improve attitudes toward learning, the instructors

teaching style should match with the students learning

style. Looking at the possibility for the students to be

cognizant of their learning styles and for the faculty to

understand the presence of diversity of styles in each

class will lead to a possibility of matching their teaching

strategies to the students learning styles which could

pave way for achieving best learning outcomes and

empower their learning experiences.

Teaching being an art, a science or both has been

an interesting issue being debated through the ages.

If teaching is an art, teaching implies inspiration,

intuition, talent and creativity from which little can be

taught. On the other hand, if it is a science, teaching

implies knowledge and skills likely to be learned.

The regulations that describe the effects of action

performed by teachers can be memorized and applied

in the classroom. If an extreme explanation is carried

out, teaching is merely the selection and application of

the formula that is suitable for every situation that

actually happens in the classroom. Given the increasing

complexity and pressures of health care delivery, new

approaches to teaching and learning, and competing

demands on teachers’ time, a nurse-teacher requires a

broad range of teaching and learning strategies that can

be used in diverse settings (Steinert, Mann, Centeno,

Dolamns, Spencer, Gelula & Prideaux, 2006).

Teaching styles according to Grasha (1996) are

more than just a teaching method, a style is a

multidimensional construct involving elements of

general modes of classroom behaviour, characteristics

associated with popular teaching methods used,

behaviours common to all college faculty, personality

traits, archetypal forms and metaphors for teaching.

Furthermore, he also emphasized in his book the three

theories of teaching-Cognitive theory, Humanistic

theory, and Behavioural theory. Cognitive theory deals

with how sensory input is transformed, reduced,

elaborated, stored, recovered and used to solve problems.

Information processing can occur at a conscious level

of awareness but our ability to do so is typically viewed

as limited. There is often too much input and too many

decisions to be made for anyone to consciously think

about and monitor everything that is required.

Humanistic theory emphasizes that development of the

whole person by integrating the cognitive and effective

aspects of the learning experiences. Instructors are

not concerned with teaching static knowledge as

they are with helping students learn how to learn.

They encourage students to explore content on their

own, to work with others to use resources when they

need them, and to reflect on the joy, excitement,

frustration, anxiety, and other exemptions associated

with learning. Behavioural theory on the other hand,

emphasizes the ways external stimuli influence

learning. Thus the manipulation of external rewards


and incentives and the creation of classroom structures

that guide and direct the actions of learners become

important. Also, the behavioural position allows

students to learn in small steps, at their own pace,

and to develop skills to competent levels. This often

means giving learners extra-time to acquire material or

to retake exams until a specified level of competence

is obtained. While instructor-generated structures and

incentives are emphasized, students are gradually taught

how to self-monitor, regulate and reward their own

actions.

The study aimed to determine the learning and

teaching styles of student nurses and if there is an

association between them. It also intended to discover

whether student nurses are uni modal or multimodal in

their styles and identified their preferred faculty

teaching style.

Research questions

The research questions are as follows:

1. What are the learning styles of student nurses?

2. Are the student nurses uni modal or multimodal

in their learning styles?

3. What are the teaching styles of student nurses?

4. Are the student nurses uni modal or multimodal

in their teaching styles?

5. Is there an association between the learning

and teaching styles of student nurses?

6. What faculty teaching style affords maximum

learning for students’ learning style?

To be cognizant of individual learning style is

already achieving the first step in maximizing the

learning outcome of every learner. Acknowledging

their styles in learning and teaching serves as a basis

for training students to utilize appropriate learning

strategies, which can help them better deal with

academic tasks and may even reduce stress. On the other

hand, faculty members can adjust their learning

methods and evaluation tools to best match the different

needs of their students. Understanding how students

learn will help improve the quality of instruction and

may empower the learning experiences of student

nurses, which could be the ultimate goal. Lastly, it will

increase academic achievement when there is

congruency of learning and teaching styles.

Method

A quantitative descriptive-co relational design

was utilized for this study. Respondents were student

nurses of School of Nursing X, Baguio City,

Philippines. Out of the 1,113 student nurses enrolled

for the school year 2013-2014, only 312 student

nurses were included. OpenEpi software was utilized

to compute the population size for the study. For data

gathering, the researchers utilized random proportionate

sampling.

Consent was obtained from students of legal age,

inclusion criteria included all level 2, 3, & 4 student

nurses enrolled for second semester, and have been

exposed to either community or clinical placement,

which is the very reason why level 1 students were

excluded.The highest percentage of respondents

belongs to the fourth year level, while the lowest

percentage came from the second year level.

The difference in the percentage of participants

was based on the proportionate sampling wherein

the numbers of respondents taken are not equal, so that

there is an identical representation of the strata.

School ethics review committee approved the

study after complying with all requirements, which

includes an informed consent that fully described the

nature of the study, researchers’ responsibilities, right

to refuse participation, risk and benefits; all of which

emphasized their right to full disclosure. It also included


the participant’s right to decide voluntarily to participate

and their right to refuse participation. Questions and

clarifications from the participants were addressed and

assured that information will never be used against them

and that data will be kept in strictest confidentiality.

Likewise, participants were not harmed physically,

psychologically or socially. Lastly, we honoured all

agreements, which demonstrated justice or the right to

fair treatment.

InstrumentThe researchers used an adopted tool from Neil

Fleming’s VARK version 7.2 for the learning styles

for student nurses, while the teaching styles

questionnaire was adopted from Grasha’s. The tools

were written in English but were intended for general

students, which prompted the researchers to modify

some terms used to fit into nursing language. It further

underwent an expert’s review for Content Validity

Index (CVI), which yielded a computed score of 0.8,

which means that the tool is valid. Furthermore, the

researchers conducted a test-retest before the actual data

gathering process. Respondent during the test-retest

included 10 student nurses who met the inclusion

criteria. Retest was conducted after one week with the

same respondents. For the computation of test- retest,

we used the SPSS software utilizing particularly the

Chronbach alpha which resulted to 0.8. The 10

participants were not included as actual respondents

for the study. The questionnaires and consent also

underwent a readability test using readability.com

website, with readability test results of average grade

level of 7.The questionnaire was divided into four parts;

the first part contains the letter to the respondents,

followed by the demographic data. The third part

consists of 16 questions for learning style and 9

questions for the teaching styles and one question

asking their preferred faculty teaching style.

The questions come with four options in each item

(multiple choice), where the respondents can choose

more than one option for identifying their styles to allow

for multimodality. Lastly, the last portion made the

respondents find out their learning and teaching style

through a simple scoring chart. The respondent

becoming aware of their learning and teaching styles

at the onset of completing the questionnaire already

achieve one step among the aims of this study.

Innumerable tools are available in the literature

in assessing the learning styles and also in examining

the teaching styles. The VARK questionnaire was

initially developed by Neil Fleming (http://vark-

learn.com/introduction-to-vark/). The questionnaire is

one of the most popularly used tools in assessing

learning styles and was used in a number of studies.

VARK learning styles has four (4) outcomes-Visual,

Auditory, Reader/writer and Kinaesthetic. Visual

learners prefer using visual resources such as diagrams,

pictures and videos, and like to see people in action.

Auditory learners need to talk about situations and ideas

with a range of people and enjoy hearing stories from

others. Reader/ writer learners on the other hand are

prolific note- takers; text books are important to them

and love extensive use of journals to write down the

facts and stories. Lastly, kinaesthetic learners prefer

hands on experience within a real-setting and for global

learning. The version 7.2 questionnaire is readily

available in the internet and anyone who wants to

identify their learning style can log on and take the test.

Satisfactory levels for validity and reliability of VARK

have been reported using factor analysis technique

(Leite, Svinicki, & Shi, 2010).

As for the assessment of teaching styles, we have

adopted a questionnaire readily accessible from the

internet, wherein nine (9) questions were modified to


fit into the nursing jargon. The questions also come

with four options in each item (multiple choice), where

the respondents can choose more than one option

for identifying their styles to allow for multi modality.

The outcome of which was based on Grasha’s teaching

styles. He identified four (4) basic teaching styles-

Formal Authority, Demonstrator, Facilitator and

Delegator. The formal authority approach focuses

on content and can be very instructor centred.

A demonstrator concentrates on the performance of

an academic procedure. On the other hand, a facilitator

tends to focus on activities. This teaching style

emphasizes student-centred learning and there is much

more responsibility placed on the students to take the

initiative for meeting the demands of various learning

tasks. Lastly, the delegator tends to place control and

responsibility for learning on individuals or groups of

students. The teacher often gives students a choice in

designing and implementing their own complex

learning projects and will act in a consultative role.

Procedure

After getting approval from authorities, the

researchers started the data collection on October

2013 from different students in the chosen year levels,

meeting the inclusion criteria. Before entering their

classrooms we used Stratified Random Sampling to

compute for the number of respondents we need

per year level and per block which resulted fourteen

(14) per block. We decided to use the fishbowl method

to select the target fourteen students per block.

The researchers agreed to select a certain group from

the existing clinical groups. For the group lacking in

number, we randomly selected by using again the

fishbowl method to know on what clinical group where

the lacking number of respondents will come from.

After permission from the faculty to get respondents

from the class was obtained, the researchers explained

the aim of the study, being guided by a script, so that

there is uniformity of information given.Before floating

the questionnaire, consent which requires name and

signature was obtained first from students who are part

of the study. The researchers provided time for the

respondents to answer the questions, and waited for

them to finish and return the questionnaires.

Researchers stayed at a minimum distance for

respondents who may ask for clarifications at anytime.

Finally, the researchers taught the respondents how to

interpret the results for them to be able to determine

their learning and teaching styles using the simple

scoring chart.

Statistical Treatment

The information obtained from the questionnaires

were coded and analyzed using SPSS 19 using

descriptive statistics for the learning and teaching styles

and preferred faculty teaching styles. Likewise,

Chi square was utilized for the correlation of student

nurses with uni modal learning styles and teaching

styles, since rule dictates that only one response

per variable is allowed, thus, the participants who

provided multiple responses were excluded from the

analysis.


RESULTS

Figure 1: Learning Styles of Student Nurses

Figure 1 presents the learning style of the student nurses. In general, we found out that that majority of

student nurses’ learning style is kinesthetic, which incurred the highest percentage (47%), followed by Auditory,

and Reader/Writer. Contrariwise, the visual learning style has the lowest percentage, and this is something that

the researchers did not expect.


Figure 2: Distribution of Learning Style Modality

As seen in figure 2, 53% of student nurses are unimodal in their learning modality, which means that the

majority of student nurses used only one style in learning. Congruently, among all the four styles of learning,

kinesthetic style still gained the highest percentage, while the least preferred learning style is still visual, similar

to the overall results of learning styles. However, under the multimodal or those students with more than

1 preferred learning style, 80% utilizes bimodal modality, meaning to say, they combine two learning styles.

The combination of auditory and kinesthetic are the most preferred, and the least is the combination of visual,

auditory and reader/writer. It can also be seen in the results that there are no students who have the combination

of visual auditory and kinesthetic as their preferred learning style.


The above figure presents the Teaching Styles of Student Nurses. The predominant teaching style is

Demonstrator (37%), however, it is closely followed by Facilitator (32%), Formal Authority at 20% and the least

style is the Delegator at 11%.

Figure 3: Teaching Styles of Student Nurses


Figure 4: Distribution of Teaching Styles Modality

Figure 4 reveals that when it comes to student nurses teaching modality, the highest percentage belongs to

unimodal (69%), which also revealed that the majority of student nurses teaching style is formal authority (39%),

a teacher-centered style, where teacher gives all the knowledge to students. As for the multimodal students,

84% use two styles or bimodal, which the highest percentage belongs to the combination of formal authority and

facilitator. But when modalities are combined, their teaching style is still demonstrator and delegator is the least

preferred teaching style.


Visual 2 1 1 1 5

Auditory 17 22 11 9 59

Reader 8 3 3 2 16

Kinesthetic 31 7 37 7 82

Total 58 33 52 19 162

Table 1: Learning and Teaching Style Correlation

Learning styleTeaching Styles

Formal authority Demonstrator Facilitator Delegator Total

χ 2computed = 29.17 χ 2.05

= 29.17 Significant

In this table, we only had 162 out of 312

respondents. As a rule for the Chi Square statistical

test that only one response per variable is allowed.

Thus, those participants who provided multiple

responses were excluded from the analysis.

The “Facilitator” and “Formal Authority” teaching

styles yielded highest proportion of kinesthetic learners.

This implies that kinesthetic learners are more inclined

to “Formal authority” or “Facilitator” strategies of

teaching. At the 5% level of significance, there was a

significant relationship between the learning styles and

the teaching styles of the student nurses. This means

that the learning style of the student is related to his/her

teaching style. Visual learners, on the other hand, are

least affected by the different teaching styles.


Figure 5 presents the preferred faculty teaching style of student nurses. Among the different teaching styles,

Demonstrator is most preferred by 39% of students which means that they like educators who take part in

demonstrating and performing how a skill is done, those who explain or teach by practical demonstrations,

exhibit the use and application of the lesson in the future, and show people how something works. However,

it is closely followed by facilitator at 33%. Obviously, the students do not prefer a teacher utilizing a delegator

style (9%).

Figure 5: Student’s Preferred Faculty Teaching Style


DiscussionAmong all the four learning styles, student nurses

turned out to be kinesthetic learners. This is probably

because the student nurses are required to develop skills

and to know how things work in the clinical area.

In order to be well knowledgeable, doing the specific

skill hands-on is a better way for them to retain the

lessons from previous discussions until the actual

performance of the nursing skills in the clinical

placement. Students tend to focus more on applying

the skills learned during lecture which is why they

turned out to be unimodal in general. This is in contrast

to what Markulis, Murff, & Strugg (2001) who posits

that the Millennial student prefers learning through

visuals.

Demonstrator teaching style, which is described

as a teacher-centered style, is a style, where the teacher

concentrates on the performance of an academic

procedure and the teacher is there to guide and assist

the learner in applying the knowledge. According to

Grasha (1996), behavioral position allows students to

learn in small steps, at their own pace and to develop

skills to competent levels. This often means that giving

learners extra-time to acquire learning and skills until

a specified level of competence is obtained.

Demonstrator is closely followed by Facilitator, which

means that there is a variation in the student nurses

teaching styles. Nonetheless, Delegator is the least

preferred teaching styles, which means that students,

when teaching, do not want to place control and

responsibility on the learners or the patient in this case.

It is also worthwhile to note that student nurses least

preferred a faculty with a delegator teaching style,

which means that they do not learn when

responsibilities are placed on them, as in the case of

reporting and reading assignments.

According to Murphy, Gray, Straja, & Bogert

(2004) from the journal entitled Student Learning

Preferences and Teaching Implications, dental students

preferred visual learning at a higher percentage

and Kinesthetic learning at a lower percentage.

The distribution of dental student scores shows a

preference for instructors who use strong visual

presentations and facilitate note-taking during lectures.

And they recommended that Dental educators should

be aware of these differences in order to explore

opportunities for making the educational experience

more productive and enjoyable. Which means that

students preferred instructors whose teaching styles

match their learning styles. Knowing their different

learning styles, the student can make strategies and

understand how they could study more effectively

(Sinha, Bhardwaj, Singh, & Abas, 2013). This would

also help the teacher make strategies on how to make

the lesson more understandable.

In the study entitled Learning preferences of

clinical students: A study in a Malaysian medical

college by Sinha, et al. in 2013, the results showed that

students preferred the kinesthetic learning style over

other learning styles since student nurses are able to

effectively learn when they can integrate the lessons

into actions, like the special skills that they are required

to learn. Another journal entitled, Using VARK to assess

changes in learning preferences of nursing students at

a public university in Jordan: implications for teaching

by Alkhasawneh (2013), found out that students, though

multimodal are kinesthetic learners. The implication

of this study is that, teachers could modify their teaching

style to suit the learning style of the students where

the teachers could give activities such as return

demonstration and role playing.

Being aware of their own learning styles, students

are able to change their learning habits which then

would result in better school performance. They can


also communicate to their instructors on what better

ways for them to understand the lessons. As for

the educators, they can change how they approach

the students with regards to the lessons presented.

They can use more than one teaching modality in order

to cover all the students learning styles. Teachers should

also give positive reinforcement to the students to be

active in the learning process especially since the current

lesson is in line with their learning style and at the same

time they can encourage the student to use all four

learning styles than to just rely on the learning style

which is convenient for them.

Since most of the students are unimodal, it is easier

for the professors to match their teaching styles to the

learning style of the student nurses. Likewise, the skills

that the course requires will be easily understood and

applied by the students, which will eventually lead to a

better outcome and performance. The good thing is that

those who are multimodal or with more than one

learning style can adapt to various teaching styles by

the teachers. Lastly, understanding the learning styles

of student nurses can help improve the quality of

teaching or instructions, and will also enable the faculty

to enhance the non-preferred learning styles of student

nurses.

We have not found any supporting journal that

resulted in a teaching style which is Demonstrator and/

or Facilitator but on the study of Chang (2010) entitled

Teacher Roles adaptation of educational technology

in the Chinese context, where they focus on perceptions

of teacher roles and their impacts on the adaptation of

educational technology in schools in a Chinese context,

results showed that teachers of Facilitator/Expert profile

and Facilitator/Delegator profile are more inclined to

adapt to the educational technology. Similarity in

geographical area of China and the Philippines could

possibly be the reason for the similarity of study results.

According to Hayward & Cairns (2007), the goal

of educators should be to prepare students to become

competent clinicians, clinical thinkers, critical

thinkers, problem-solvers, collaborators, team players,

self-directed learners and effective communicators.

This applies to the nursing profession; student nurses

being mindful of how they teach would allow them to

instill learning in their finest and most comfortable

technique. Hence, confidence and competence are

embodied by the student nurses.

Being required by the course to educate the client/

patient, the student nurses must develop a teaching style

that better fits the specific needs of the client. Facilitator

as a teaching style is a learner-centered teaching style,

allowing teachers to create situations for learners to

practice what was taught. Student nurses also act as

Facilitator in group discussions, like Mothers’ class or

Ward class in order to ensure that the learners

understand what is being taught.

Conclusion

The study aimed to determine the learning and

teaching styles of student nurses and if there is an

association between them. It also intended to discover

whether student nurses are unimodal or multimodal in

their styles and identified which faculty teaching style

affords maximum outcome for student’s learning styles.

Findings revealed that majority of student nurses’

learning style is Kinesthetic and their teaching style

is Demonstrator, which was also found to be

significantly associated. In general 8 out of 10 students

are unimodal in their learning and teaching styles.

Lastly, their preferred faculty teaching style is similar

to their teaching style, which supports the concept that

teachers teach the way they learn.

This study shows evidence that student nurses’

learning and teaching styles are varied, which


exemplifies the uniqueness of every learner, but clearly

describes the contemporary nurse-dynamic and diverse.

This diversity in styles provided more evidence that a

variety of modes of teaching and learning should be

used by faculty and students to increase learning

outcome and academic achievement. Being cognizant

of the learning and teaching styles of student nurses is

highly important for both the students and the faculty.

Students’ awareness on how they learn best contribute

to their own learning. The findings also support the

on-going paradigm shift to Outcome-Based Education

(OBE) which requires the students to demonstrate

the skills and course content that they are required

to learn. Lastly, the study provided useful information

for improving the quality of teaching and learning

experiences of student nurses.

Recommendations

Future studies could be carried out in various

schools of nursing utilizing bigger and equal gender

population. Replication of the study with faculty as

respondents is highly encouraged. Conduct assessment

of learning style at the onset of classes/clinical

placements so that faculty will become aware of the

diversity of learners that will compel them to deliver

diverse teaching methods to improve the learning.

Furthermore, we recommend that before educating and

enlightening the patient in the clinical and community

area, assessment of the learning style of the patient could

also be done initially through oral inquiry so that

there would be better knowledge acquisition. Lastly,

to develop a more valid tool for assessing the learning

and teachings styles of student nurses.

Acknowledgement

This research was conducted without any funding

from any person or organization, and therefore declares

no conflict of interest. Nevertheless, we are grateful

for the panel members and the critique group who gave

valuable suggestions to improve our final output. Lastly,

we also give credit to Saint Louis University for the

publication support.

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