1. Ward and Peterson Case Study Comprehensive Exam Part II Kimberly Whitfield April 14, 2011

2. Who is this case study about? Dr. Elizabeth Ward ◦ University faculty member who teaches Healthcare in the nursing program ◦ Expert in multicultural understanding within nursing Catherine Peterson ◦ Instructional Designer for the Office of Extended Studies (OES)

3. What is this Case Study About? ◦ Designing and Developing a Web Course for Elizabeth’s existing Healthcare in Multicultural Environments Course and the Instructional Design implications

4. Case Analysis Questions Given Elizabeth’s passion for teaching and her expert knowledge of the course content, how is this course redesign likely to affect Elizabeth’s interactions with her students? What support could you provide in this environment to protect students who might make painful discoveries about themselves? What strategies could be used to deal with inappropriate and excessive disclosure of personal information? Given the content and the learners, develop a course outline that will enable learners to achieve the course goals Suggest appropriate methods for assessing learner performance.

5. Implications for ID practice What are the advantages and disadvantages to using the web to deliver a course with a high level of affective subject matter? What are the benefits and challenges of offering a course in cross-cultural communication via the web? Discuss when and how it might and might not be appropriate to use the web to implement authentic assessment strategies.

6. Elizabeth’s Web Course Information Title – Healthcare in Multicultural Environments Goal - “Students to arrive at an understanding of the influence of cultural variation on clinical nursing practice and to use a culturally informed theoretical framework when considering patients’ symptoms during a cross-cultural patient-provider encounter.”

7. Why is this Important? Instructional Designers need to know what Elizabeth’s course is about in order to determine the Instructional Design models and theories to follow

8. Domains of Learning Cognitive – The development of understanding and intellectual abilities and skills Psychomotor – The development of skills related to manual tasks and physical movement Affective – Focus is on internal processes or categories of behavior within affective education as a process or end-product.

9. Krathwohl, Bloom and Maslas’ Taxonomy of the Affective Domain Be aware of Cultural Influences when examining patients

10. Martin and Reigeluth’s Conceptual Model of the Affective Domain Components of instructional value DimensionsKnowledgeSkillsAttitudes Emotional DevelopmentKnowing that others experience the same emotions you do such as joy and anger Recognizing emotions, Controlling emotions I want to be happy. I don’t like to be angry. Moral DevelopmentUnderstanding moral and ethical rules of the culture, such as caring, justice, equality Moral reasoning skills. Problem solving skills in the realm of morals I want to be honest. I am in favor of having ethical standards. Social DevelopmentUnderstanding group dynamics and democratic ideals, such as the role of the facilitator Social skills, including interpersonal communication skills I want to interact positively with others. I am opposed to resolving disagreements by fighting. Spiritual DevelopmentKnowledge of religious precepts about the spiritual world, such as the nature of the soul. Skills for getting in touch with your inner self. Ability to love others selflessly. I want a spiritual life. I am in favor of prayer to build a relationship with God. Aesthetic DevelopmentUnderstanding the subjective nature of aesthetics, such as the relationship between ones’ values and one’s judgments Skills for assessing aesthetic qualities. Skills for generalizing aesthetic creations I want to surround myself with things of beauty. I appreciate an elegant theory. Motivational DevelopmentUnderstanding the internal and external rewards for sustained activity such as joy and sense of accomplishment Skills for developing ones’ interests, both immediate and life long I want a career that I enjoy. I am opposed to hobbies related to guns. Problem solving skills in realm of moral reasoning, specifically multicultural awareness Intervene cultural awareness development by integrating into course curriculum

11. Learning Theories Behaviorism – B.F. Skinner, An orientation in psychology that emphasizes the study of observable behavior Cognitivism – The mind is an information processing system where prior knowledge plays an important role in learning Constructivists – Piaget, Learning is a process where learners construct new ideas or concepts based on past knowledge and experience

12. Teaching & Learning from Three Different Theoretical Perspectives Adapted From H. H. Marshall (1992) Created by Mahnaz Moallem, MIT500 BehavioristCognitive ConstructivistSocial Constructivist LearningAcquisition of facts, skills and concepts Occurs through drill and practice Active construction and reconstruction of prior knowledge Occur through multiple opportunities and diverse processes to connect new knowledge to what is already known Occurs through interaction with others and the environment Involves deep processing Collaborative construction of socially defined knowledge and values Occurs through socially constructed opportunities Occurs through interaction with others and the environment Involves multiple processing (how to learn), and interpretations ( it means to learn, which knowledge is of value) TeachingTransmission presentation (telling)Challenge, guide thinking toward more complete understanding Co-construct knowledge with students Expand repertoire of options of how to go about learning Role of Teacher Predefined as an adult Primary source of knowledge Manager or supervisor encourage on-time task completion Correct wrong answers Self or anyone with expertise A source of knowledge (along with student, materials, and the environment) Facilitator or guide Self or anyone with expertise A source of knowledge (along with student, materials, social artifacts, and the environment) Facilitator or guide Co-participant Role of PeersNot usually consideredNot necessary, but can stimulate thinking, raise questions Ordinary part of the process of knowledge construction Contribute to definition of knowledge (in inter- subjective space of groups) Help define opportunities for learning Role of Students Recipient of knowledge Worker Active listener, direction-follower Complete work on time Active construction (within mind) Generator, constructor Active thinker, explainer, interpreter, questioner Understand, question, explain Active construction with others and self Source of knowledge (group and individual within group) co-generator, co-constructor Active thinker, explainer, interpreter, questioner Understand, question, explain Co-construct, interpret social context

13. Structured design for Attitudinal Instruction (SDAI) Kamradt and Kamradt Theory fosters Affective Domain Help learners change an attitude Examples: ◦ Learners will have a fuller understanding of how culture influences health care practices ◦ Learners choose to change the attitude of cultural understanding, and events help the learner maintain the new attitude and transfer it to real-life situations

14. SDAI Instructional Strategies Move all three components of attitude (affective, cognitive and behavioral) the same amount in the same direction, using rapid shifts in instructional tactics, from one component to another Offer learners a safe environment in which to try the new attitude

15. Course Structure for Elizabeths’ Web Course Separate lessons into learning chunks in sequential order Align Gagne’s Events of Instruction with course outline components to ensure learners achieve course goals Created instructional strategies to apply Gagne’s Events when creating Elizabeth’s Web course. ◦ Based my instructional strategies on Zhu and StAmant’s method which uses Gagne’s Events applied to Web Teaching

16. Gagne’s Nine Events of Instruction Course Outline ComponentsInstructional Strategies for Web Course Application Gaining AttentionCourse and Lesson Introduction Introduction: Instructor tells stories of how culture affects communication in healthcare. Assignment: Students will find similar examples on the web and share their findings by posting them (use course discussion, blog, etc.) Inform learners of objectives Learning and Performance Objectives Objectives: State the following course objectives at the beginning of the course. Recognize the broad cultural variation in clinical nursing practice. Apply a culturally informed theoretical framework. Stimulate recall of prior learning Pretest, Introduction, Case studies Introduction: Ask learners to remember prior experiences in personal multicultural encounters and post their thoughts to share with others. Case Studies: Instructor presents a case study and provides solutions as an example of what is expected of the learner at the end of the lesson. Presenting the stimulus(content) Lessons and TopicsLessons or Topics: Present Videos of multicultural encounters with patients which describes cultural differences. Providing learning guidance Lessons, TopicsLessons: Ask focused questions about cultural differences for learners to think about while watching the videos. Eliciting performance Exercises, AssignmentsExercises: Ask learners to review the Genogram Development Tool from the Web Course. Then ask learners to create their own Genogram using the tools provided within the course. Providing FeedbackFeedbackFeedback: Instructor will provide feedback to exercises, assignments, assessments before moving on to the next task. Use the Web Course forum, discussion, chat, blog or email to facilitate communication and answer questions. Assessing performance Case Studies, Assessments or Assignments Assessment: Watch the Video Vignettes of patient-provider encounters and engage in online dialog to discuss them. Case Studies: Provide case studies with posed so learners can practice their target skills by using relevant content knowledge to help them achieve their learning objectives. Application of Gagne’s Events of Instruction using Instructional Strategies in a Web Course Outline

17. Course Outline Healthcare in Multicultural Environments Course Introduction Provide course title, learning objectives, content summary, instructor contact information, materials or equipment needed to complete the course and a brief instructional flow of the course. Identify prerequisites and prior knowledge learners must have before taking the course. Include a time frame of how long it will take to complete the course. Pretest Test learners’ prior knowledge and align test items with performance objectives. Lesson 1 Introduction to health care in multicultural environments. Demographic trends, diversity vocabulary and common clinical challenges in multicultural health care environments Introduction Include title, time frame, content and purpose of the lesson Identify prior knowledge required List materials/Equipment needed to complete lesson Provide instructional flow of lesson Performance Objectives Identify performance objectives for each lesson and/or topic Topics List lesson topics Provide content, resources, case studies and materials Provide examples Exercises, Assignments and Assessments Provide lesson or topic exercises or assignments as opportunities to practice what they have learned Include enough resources and materials for learners to succeed Assessments test learners’ knowledge after instruction Align test items with lesson performance objectives Provide feedback Provide feedback at the lesson or topic level or both depending upon the complexity of the task Redirect the learner to review lessons when they have not successfully completed the task Praise the learner and allow them to advance to the next topic or lesson when they successfully complete tasks

18. Course Outline Continued.. Lesson 2 Genogram A picture of the relationships within a family, self-disclosure, benefits of self- awareness and skills needed to assess patients’ heritages Lesson 3 Self-Awareness Self-identity exercises, skills needed to assess patients’ culture Lesson 4 Theoretical Frameworks in nursing practice. Advantages of a theoretical approach to nursing care, including cultural assessment Lesson 5 The viewing of symptoms through a theoretical lens Symptoms as merely symptoms, explanatory models, idioms of distress, semantic illness networks, fold illnesses and the analysis of illness narratives Lesson 6 Cross-Cultural communication standards and skills Outcomes of provider-client (mis)communication, implications of differences between patients and providers in terms of language, semantics and disease classification and the elicitation of illness narratives cross-culturally Posttest – (After course completion) Test learners knowledge after instruction Align with performance objective Develop similar or parallel test items used in pre-test Provide feedback – (After posttest) Provide feedback at the end of the posttest Redirect the learner to review the lessons with poor assessment results Praise the learner for successful completion of the course

19. Assessments for Affective Domain Case Studies - Learners can practice their target skills by using relevant content knowledge to help them achieve their learning objectives Videos - Watch the Video Vignettes of patient-provider encounters and engage in online dialog to discuss them Projects - Learners will form groups and apply using culturally informed theoretical frameworks and cross-cultural communication skills by completing a course project Report Paper - Students to reflect on their understanding of the course objectives by writing a commentary about how they felt at the beginning of the course; how they feel now and how will they put what they have learned into practice Likert Scale -Learners can check a box to determine if they “strongly agree”, “agree”, “undecided”, “disagree” or “strongly disagree” in response to attitudinal statements

20. Challenges and disadvantages for sensitive subject matter Develop trust and ensure privacy when assessing learners thoughts and feelings about subject matter ◦ Prevents exposure of inappropriate personal information. ◦ Promotes honest responses from learners May not know future audience Designer will know intended audience but may not know future audiences Have learners register for course attendance and change course as needed Scaffolding and Supporting Student Learning ◦ Support learners, focusing tasks, environment, teacher and learner ◦ Genogram example: learners may discover painful family facts when isolated from group. May not be appropriate to develop personal Genograms but use a biography of a “fictional” student instead

21. Benefits and advantages for sensitive subject matter The Web enables use of multimedia content Easier to create and edit course content ◦ Can be embedded or linked to from within course ◦ Example: VoiceThread Ensures Privacy ◦ Learners can discover attitudinal concepts about themselves without fear of exposure ◦ Anonymity can be beneficial and allow learners freedom of expression without bias or intimidation ◦ Makes learning more personal as Gagne states, enhance retention and transfer learning

22. Conclusion Instructional Designers can design and develop a successful course for Web-based instruction as long as they know: ◦ Domains of Learning ◦ Learning Theories and Models ◦ Instructional Design Theories and Models ◦ How to apply Theories and Models ◦ Instructional Design Process  Analyzing, designing, developing, implementing and evaluating instruction intended for successful learning outcomes Design for the Affective Domain may be more difficult than for the other Domains of Learning it is possible, and successful learning outcomes can be obtained when these principles are followed

23. References Dick, W., Carey, L., Carey, J. (2005). The Systematic Design of Instruction, Boston, MA: Pearson Education Inc. Marshall, Hermine H. (1996). Clarifying and Implementing Contemporary Psychological Perspectives, Educational Psychologist, 31: 1, 29 — 34 Marshall, G., Scott, J. ED (2005). The Oxford Dictionary of Sociology, New York, NY: Oxford University Press. Moallem, Mahnaz (2008). MIT500 Instructional Systems Design: Theory and Research [Lecture notes]. Wilmington, NC: University of North Carolina Wilmington, Department of Instructional Technology. Reigeluth, Charles, M. (1999). Instructional-Design Theories and Models: A New Paradigm of Instructional Theory, Volume II (pp. 485-509, 551-561 and 564-590). Mahwah, NJ: Erlbaum. Seels, Barbara and Glasgow, Zita (1998). Making Instructional Design Decisions, (pp. 60-64 and 179-187). Upper Saddle River, NJ: Prentice Hall. Zhu, Pinfan and StAmant, Kirk (2010). An Application of Robert Gagne’s Nine Events of Instruction to the Teaching of Website Localization, Journal of Technical Writing and Communication, Vol. 40(3) 337-362, 2010.