My previous teaching session on basic life support training enabled my learners to understand the principles of CPR training and adequately developed their skills for teaching high school students to perform Cardiopulmonary resuscitation. In the whole training session, I adopted reflective teaching technique which had considerable and tangible values. The achievement evaluation of each learner and lesson satisfaction levels were analyzed to elicit information to the effectiveness of the designated teacher. The learners compared the different teaching approaches as a reflection on this information was very instructive. They were made a ware that the effectiveness of the approach depended on the objectives of the teacher. Since the ultimate goal of reflective teaching depended on total teaching practice, I ensured that learners were responsible for the total development and presentation of the lesson. Thus, I provided the teaching objective and a common evaluative instrument when planning for the reflective teaching session (Kember, 2001). In this paper, I will review the related literature that support reflection in clinical practice, discuss the planning and implementation of cardiopulmonary training program for learners, discuss the teaching strategies, evaluate the teaching plan, and give recommendations.
According to Moore (2005), Cruickshank and associates developed reflective teaching as a result of a need to give laboratory and clinical teaching practice. In reflective teaching, teachers engage in the whole act of teaching. This means that; they plan, teach, execute and evaluate. The purpose is to stress on the knowledge of finding out whether the learners actually learnt and measuring their level of satisfaction with the instruction. In this effect, reflective teaching calls upon the teacher to analyze and reflect on the teaching itself (Moore, 2005).
As specifically conceived by Cruickshank and associates, reflective teaching consists of components and characteristics such as: one, dividing learners into various groups; two, selecting one learner in each group to teach the group; three, the designated teacher is made to teach toward identical teaching objectives, applying his or her own teaching methods; four, the designated teachers are told to focus on learner achievement and learner satisfaction; five, learners are requested to be themselves; seven, there must be evaluation or measurable product arising from the teaching experience in order to determine the teaching and learning outcomes; and eight, the reflective teaching experience is followed by a large group discussion where the whole class reflects on and discusses the different teaching acts that took place (Moore, 2005).
This section discusses and argues about Cardiopulmonary Resuscitation training traditional model of learning as used in the procedural instruction. This learning model puts positive regard to the teacher as he facilitates learning. Kaye (1991) wrote a paper chronicled “The Problem of Poor Retention of Cardiopulmonary Resuscitation Skills May Lie with the Instructor, Not the Learner or the Curriculum,” emphasizing on this point (Kaye, 1991). Other studies have discovered that cardiopulmonary instructors had restricted or limited knowledge of the courses they taught, were not able to understand or follow basic life support teaching practices that are recommended, did not read their instructor manuals, and could not even excel in a Cardiopulmonary test (Braslow, 1985). It is not surprising that Kaye (1991) found that 10% of instructors were considered by students as incompetent, 9% of the learners stated they would not perform a cardiopulmonary resuscitation after completion of the course, and 23% stated mistakenly they could be legally sued if the performed a cardiopulmonary resuscitation on a stranger.
This section reviews the literature on the basic life support procedures that learners could perform incase of an emergency. Basic Life Support trainees must be made to understand the most important procedures to perform as first aides. For instance, starting rescue breathing immediately incase the victim is not breathing. The learners must understand the process so well that they can proceed automatically. This is because every second they may spend recalling the proper procedure is a vital second lost in resuscitating the patient. According to Thygerson (2004), the procedure for performing basic life support involves eight steps; checking the victims responsiveness, calling EMS or 911, opening airway, checking breathing, checking circulation, performing cardiopulmonary resuscitation, rechecking circulation, and performing rescue procedures based on findings.
Planning and Implementation of Basic Life Support (CPR) Training
My last teaching session was inscribed by constructivist learning theory, a theory that is learner centered. Based on this constructivists view, my teaching strategy was to elicit learning from the previous learning experiences. I conducted a training session that legitimized and opened the learner’s interaction with the learning content. I did not wait until the learners had developed expertise before they interacted with the learning content. I encouraged the learners to explore the content, allowed them to freely handle it, relate the content in their own experiences, and even challenge it. The aim was to involve the learners as much as possible in the process of acquiring and retaining knowledge learnt (Hampson, 2006).
My planning and implementation of the training session had a clear shift of focus from the dominant role of the teacher to the learner. However, what I did was significant only in relation how those actions addressed the student’s learning. The actions that I took featured at all times learners and what they were doing. The constructive learning view deemphasizes teaching strategies and methods incase they are considered to be separate from the subject matter and learning structure of the course (Hamilton, 2004).
Almost the entire information I taught about Cardiopulmonary Resuscitation and the teaching strategies had been passed down by tradition. Typically, a teacher or instructor is a role model to be admired by learners. According to Ornato (2005), few instructors realize how they make learners feel, and how their well intentioned words distract the learners from the important skills that they have come to learn. As a professional teacher, I know that when I give anecdotes and depart from the script, a decrease in written test scores (Ornato, 2005). Like learners I moved through my CPR training session in a manner that reflected much focus on students and learning. The teaching strategies involved were lecture, discussions in groups, and simulations and were systematic and moved through developmental stages as follows: The initial step taught learners on how to determine a victim who is unresponsive. I demonstrated to them the simple ways of determining the victim’s unresponsiveness, for instance, tapping gently the victim’s shoulder and shouting, “are you okay?” on the victim’s both ears in case he has difficulty in hearing. I also explained the simple action to learners as meant to ensure that they don’t start CPR on a conscious victim (Ornato, 2005).
Secondly, I demonstrated to learners how to quickly scan the victim to detect major injuries, particularly to the head and neck. I also taught them how to request for assistance by activating the EMS immediately if the victim is unresponsive; to prevent unnecessary time loss in acquiring advanced cardiac life support. They could also request a bystander to activate the EMS, normally by calling 911 (Alderman, 1997). If he or she may be alone and no bystander is available, they may activate the EMS themselves (American Academy of Orthopedic Surgeons, 200).
Thirdly, I taught the learners on how to place the victim in the recovery position, that is, if they were able to detect that the patient was breathing. If the victim’s breathing capacity was uncertain, I taught them on how the victim should be rolled over, keeping the head, neck and shoulders aligned to prevent any twisting of the body. I emphasized to them to ensure that the victim must be on a firm, flat surface when a procedure is carried out. If the victim is in the bed, learners should know that cardiac resuscitation board can be used. Incase a head or neck injury was suspected, they learnt how to move the patient as little as possible to reduce the risk of paralysis (Aliot, 2000).
Fourthly, I discussed and demonstrated to students on how to ensure an open airway for the victim by performing rescue breathing as an important maneuver. The blockade by the tongue is the most common cause of airway obstruction in unresponsive victim. By opening the victim’s airway, the lower jaw moves forward, bringing the base of the tongue forward also away from the back of the throat (Marino, 2006). The simplest way to open the victim’s airway was by tilting the head and lifting the chin. Breathing can sometimes be restored by simply opening the victim’s airways. Any visible object or vomit should be removed (Cohn, 2008).
Fifth, the immediate step after unresponsiveness has been determined and the air way opened, I taught them on how to look, listen, and feel for breathing. They also learnt how to look for any visible movements of the patient’s chest, listen for air by placing their cheeks next to the victim’s mouth and nose, and feel air against the victim’s cheek. The evaluation procedure should last about 10 seconds. If signs of breathing are detected, I taught them on how to keep the airways open and continue monitoring the patient’s breathing until assistance arrives.
Sixth, students learnt how to begin rescue breathing incase the patient doesn’t start to breathe if the airway has been opened. Show them how to use one way mask valve as required by the facility’s policy. Demonstrate how to connect the one way valve to the mask, and placing the mask over the victim’s nose and mouth (Williams, 2002).
The feedback was an important component in reflective teaching to the designated teachers. I ensured that this feedback was given as promptly as possible after the teaching session, and was objective. To ensure the objectivity, the instrument used for evaluation was based on identified teaching skills that were effective. The learning feedback can be given by having the instructor and the learners complete and share the information for evaluation with the designated teachers. Incase the lesson was video taped; evaluation can be completed by the designated teachers on their own. The instructor must also ask learners to complete a learner satisfaction form. This feedback on lesson satisfaction can be used by the teacher in addressing the areas the learners found deficient in a lesson presentation. Finally, I awarded grades as an important ingredient in teacher preparatory program. The evaluation form I used was based on the program criteria for effective teaching.
I used a number of simple and effective definitive teaching strategies in Community Cardiopulmonary Resuscitation training. These teaching methods included: one, the lecture and discussion group method. The lecture teaching strategy was used for the aim of revising the core material and group discussion assisted in providing valuable opportunity that assisted in sustaining learner interest in the lecture. For my lecture teaching strategy to have succeeded, it had upheld the following key points; one, consciousness, simplicity, eye contact, variation in speed and volume, and use of personal experience and questioning (Mackway-Tones & Walker, 1999); two, practical skill session, as CPR essentially involved practical skills. Therefore, it was important for me to ensure that the training session was provided with plenty of time for these skills to be taught and effectively practiced. Practical skills session provided learners with the opportunity to learn CPR skills and be able to debate relevant issues (Gaberson, 1999).
There are three important approaches that I adopted to facilitate effective learning and teaching regardless of the methods I used in teaching. These three approaches were: one, set which ensured that the teaching and learning environment that includes lighting, seating arrangement, audiovisual aids and others were adequate for training; two, dialogue which ensured that the content was presented in a clear, logical, and formal manner at a level which the enabled learners can understand easily; three, closure which included provision of time for questions and queries from learners (Jowett, 2007). This provided me as an educators a concise summary that clearly ended the teaching session (McTaggart, 1997)); four, in teaching and Learning, I was able to understand and apply the basic teaching and learning principles in a teaching setting. These principles occur in three learning domains; cognitive, affective and psychomotor (Roberta, 2001). At the end of the teaching session on CPR learners were able to; one, to check the dangers, hazards, risks, and safety of the patient; two, check the patient’s responsiveness “unconsciousness”. Incase the patient was not responding, were able to seek for help immediately; three, open airway and investigate signs of life; four, give two initial breathe incase the patient is not breathing properly; five, to give thirty chest compressions; last but not least, continue CPR until qualified personnel arrive or signs of life are witnessed (Young, L & Paterson, 2007).
My teaching strategies ensured vitality throughout the training session. This made the students to come out with an expectation that the basic life support training session held interest and significance on top of what they had experienced in clinical practice. I used group problem solving teaching strategy for the purpose of achieving one on one feedback with individual learners at the conclusion of the training session (White, 1997).
Gaberson (1999) considered five important factors in choosing methods to use of clinical evaluations such as Basic Life Support training evaluation: first, the evaluation criteria sought to find out how the learners were achieving the clinical objectives and the competences, if the aim was formative, or the extend to which learners achieved those objectives, if the aim was summative (Billings, 2005). As an instructor, I will first think of the clinical objectives to be evaluated in deciding the methods of evaluating my learners, and then determine specific method or methods that would give data on them. This process required the evaluation strategies to be matched to the clinical objectives or competences; second, I did not rely upon on one method only as an evaluation method that could be used for determining given objectives or competences. Instead, I selected the most appropriate methods for meeting the objectives and competences of learners (Bradshaw, 2006). The variance of evaluation strategies provided broader data base for appraising learner’s performance; third, the methods of evaluation should be relevant for the type of the activities the learners engage in. For example, I used the rating scale to rate observable behavior. This method can be inappropriate if the clinical activities are such that the instructor has the limited opportunity to observe the behavior to be rated. Evaluation methods, such as, written assignments may be applied; fourth, I was clear to the learners about whether the evaluation was for the purpose of formative or summative and effectively communicated to learners. Formative intention would mean the evaluation methods would provide feedback for further learning and are not included in the clinical grade; fifth, besides appropriateness of the strategy for clinical activities, I also considered the time stipulated by the department for completing evaluation, giving feedback, and allocating grades, if intended for summative evaluation (Gaberson, 1999).
Evaluation of the Teaching Plan
I have gathered several sheets of evaluation from my colleagues who attended my teaching sessions. Overall, I found their remarks about my teaching quite encouraging and supportive. Their genuine suggestions and comments were very important to me sequentially as it will act as benchmarks that will assist me improve my future teaching sessions. One of the comments touched on the achievement of eye contact with the learners. Further comments and suggestions centered on the teaching and learning processes. The outstanding argument most argued was the fact that I overlooked the need to stress the strong concern and enthusiasm to the subject, and that my session conclusion was not quite clear. I was able to determine the progress of my learners towards attaining the learning objectives of Basic life support training and developing cardiopulmonary resuscitation competencies. I used tests in class, clinical practice observations, and other strategies of assessment, to lay the basis for further instruction. In the session, I specified the intended learning outcomes which included; ability of learners to determine the victim’s level of consciousness, scan the patient to detect major injuries, place the victim in the supine position, ensure open airway, use the jaw thrust maneuver to open the airway incase the patient has a neck injury, perform rescue breathing, and perform chest compressions.
I took some time at the end of my teaching session to evaluate myself. This was quite important to assist me clarify the level of my presentation. This helped me realize that during my teaching, I was surrounded by many factors that influenced my session presentation. In my own assessment, these influences pointed out both my strong points and weak points.The strong points I determined having during teaching session included: good preparation for the teaching session and its subsequent presentation. I had gathered information that was up to date and evidenced based from various sources. This reflected high academic standard on my part; I used appropriate voice variations that suited the students learning environment and this made me feel to have attended to students well; I placed substantial focus on eliciting the acquired skills for assessment at the end of my teaching session. I demonstrated skills clearly and effectively to learners, step by step; last but not least, I interacted well and effectively with my students by asking questions and initiating conversation with them throughout the session.
During my preparation and information gathering for my session, I learnt many important points. I collected formative information by observation and questioning of learners, diagnostic quizzes, small group activities, written assignments and other activities that learners completed in and out of class (Higgs, 2000). I used formative evaluation as an integral part in my teaching process in clinical practice. I observed my students continuously as they learned to provide cardiopulmonary resuscitation, questioned them about their understanding and clinical decisions, discussed these observations and judgments with them, and guided them on how to improve their skills (Eisenberg, 1995). I gave feedback to learners through formative evaluation about their progress in achieving the goals of Basic Life Support training and how they can further develop their knowledge and skills. I commonly used anecdotal notes to record observations and judgments and to communicate them to learners (Braunwald, 2002). My major concern was about what impact it might reflect on my teaching. From the session, I realized that I can speak with confidence to students. It was a wonderful experience to me and I believe I have built my teaching skills. Furthermore, this session has raised my confidence levels in anticipation of my teaching career in future.
I also managed to determine my weak points in the process, which were as follows: I did not link satisfactorily the theory and practice in my presentation; I accorded little consideration learners about whether effective learning was taking place; I realized that I did not explain adequately what the learning objectives were and aim of the teaching session right from the beginning of the lesson. Probably, this could have assisted my learners understand what was required on them from start and not confined at the end of the session; lastly, I realized that being an international student, I had language barrier. This may have impeded my learners in terms of effective understanding on what I was teaching and therefore making them miss some of the vital points required in the session.
My session evaluation served two key purposes: formative and summative evaluation aims (Oermann, 1999). Through formative evaluation, I was able to asess the student’s progress towards achieving the Basic Life Support training objectives and competency demonstration in practice (Emerson, 2007). Formative evaluation assisted me in identifying the learners further learning needs and where additional clinical instruction was required. I used formative clinical evaluation for learning needs diagnostic purposes as a basis for further instruction and for grading intentions. It is displayed a feedback loop to instruction. Through this feedback to my learners, I reinforced successful learning of cardiopulmonary resuscitation and identified the errors of learning that required rectification (Carol, 2005).
I utilized a lot of time in discussions with my students which was time consuming I would also recommend the use of CPR prompting devices to encourage learners to practice more effectively during the time available and for longer periods of time. I would also recommend the enhancement of instructors practice time on the Basic Life Support training. In most cases, the responsibility of maximizing the time for practice is the responsibility of the instructor. It is essential for teachers to minimize the information that is not essential that consumes up practice time. Instructors with personal experience in pre-hospital resuscitation should add credibility to the training course by sharing personal experiences with learners and also utilize valuable time required for skill practice. Actual instructor’s personal experience relayed to learners often results to them remembering the story and missing the vital underlying message.
- Alderman, C. (1997). Emergency Bystander Life Support Training. Emergency Nurse 5: 10-1
- Aliot, E, Clemente, J. (2000). Fighting Sudden Cardiac Arrest.
- American Academy of Orthopaedic Surgeons. (2006). Emergency Care Transportation of the Sick. New York: Jones and Bartlett.
- Beukers, H, Henderson, M. (1989). Clinical Teaching, Past and Present. Manchester: Radopi.
- Billings,S. (2005). Teaching in Nursing. Sydney: Elsevier Health Sciences.
- Bradshaw, M. (2006). Innovative Teaching Strategies in Nursing and Related Health Professions. New York: Jones Bartlett Publishers.
- Braunwald, E. (2002). Harrison’s Advance in Cardiology. New York: McGraw-Hill Professional.
- Burton, G, Hodgkin. (1991). Respiratory Care. New York: Lippincott.
- Carrol, L, Goldenberg, D. (2005). Curriculum Development in Nursing Education. New York: Jones and Bartlett Publisher.
- Carter, P. (2007). Lippincott Textbook for Nursing Assistants. New York: Lippincott Williams & Wilkins.
- Cohn, L. (2008). Cardiac Surgery in the Adult. New York: McGraw-Hill Professional.
- Eisenberg, Damon, Mandel. (1995). CPR Instruction by Videotape. Ann Emerg Med. 5:25:10-1.
- Emerson, R. (2007). Nursing Education in the Clinical Setting. Sydney: Elsevier Health Sciences.
- Giberson, K, Oermann, M. (1999). Clinical Teachers Strategies. New York: Springer Publishing Company
- Golper, L. (1998). Sourcebook for Medical Speech. Cengage Learning.
- Hampson, (2006). Practice Nurse Hand Book. New York: Wiley Blackwell.
- Hamilton, R. (2004). Nurses Knowledge and Skill Retention following Cardiopulmonary Resuscitation Training. Journal of Advanced Nursing, 51 (3), 288-297.
- Higgs, J. (2000). Clinical Reasoning in Health Professions. Sydney: Elsevier Health Sciences.
- Jeffrey, M. (2006). Teaching Cultural competence in Nursing and Health Care. New York: Springer Publishing Company.
- Jowett, N, Thomson, & Boyle. (2007). Comprehensive Coronary Care. Sydney: Elsevier Health Sciences.
- Kayes, W., & Rallies, S. (1991). The Problem of Poor Retention of Cardiopulmonary Resuscitation Skills. Resuscitation 1991:21:67-87
- Kember, D. (2001). Reflective Teaching and Learning in Health Profession. New York: Sage Publishers.
- Long, R. (2005). Using Simulation to Teach resuscitation. Critical Care Nursing Clinics of North America, 17, 1-8.
- McAllister, L. (1997). Facilitating Learning in Clinical Setting.
- Ornato, Peberty, M. (2005). Cardiopulmonary Resuscitation. New York: Humana Press
- Tanner, C. (2009). Expertise in Nursing Practice. New York: Springer Publishing Company.
- Thygerson, American Academy of Orthopedics Surgeons. (2004). First Aid, CPR, and AED. New York: Jones and Bartlet.
- Wesberg, J. (1993). Collaborative Clinical Education. New York: Springer Publishing Company.
- White, R, Ewan, C. (1997). Clinical Teaching in Nursing. Nelson Thornes.
- Williams, & Wilkins, L. (2002). Handbook of Geriarics Nursing Care. New York: Wolters Kluwer Health.