NR 535 Week 3 Learning Theory Brief Example

Learning Theory Brief: Why New Graduates Who Can Name Every Chamber in Class Freeze at a Bubbling Water Seal at 0300, Explained by Cognitive Load Theory Rather Than Three Theories at Once

Student Name

College of Nursing, Chamberlain University

NR 535: Theoretical Foundations and Instructional Strategies for the Nurse Educator

Instructor Name

Month Day, Year

Learning Theory Brief: Why New Graduates Who Can Name Every Chamber in Class Freeze at a Bubbling Water Seal at 0300, Explained by Cognitive Load Theory Rather Than Three Theories at Once

The Failure

Every quarter, new graduate nurses in our residency program complete a chest drainage session in the skills lab and pass its written check. They can label every chamber of a three-chamber drainage system on a diagram and define tidaling, bubbling and suction. Within their first months on our thoracic surgery and pulmonary step-down unit, a predictable number of them then struggle at the bedside. In the last year, the unit recorded four events in which a new nurse clamped a chest tube during transport without an order, two in which a nurse called the surgical resident at night about expected bubbling on a patient with a known air leak, and many more occasions, described by charge nurses, in which a new nurse stood at a drainage system unsure what to check first. The knowledge was present in the classroom and absent at the bedside.

This brief uses one learning theory to explain that failure and to change how the session is taught. Several theories could be applied, and I explain at the end why I did not choose them. The point of choosing one is that a single theory, applied closely, produces specific predictions about what to change, while a paragraph on each of three theories usually produces none.

The Theory

Cognitive load theory begins from the limits of working memory. Learners can hold and process only a small number of new elements at once. When a task contains many elements that interact, so that one cannot be understood without the others, its intrinsic load is high for a novice. Instruction adds its own load, which can help learning if it builds useful mental structures and hinders it if it spends working memory on things that do not. Once a learner has built a schema that organizes the elements into a whole, the same task places much less demand on working memory, which is why experts find simple what novices find overwhelming (van Merriënboer & Sweller, 2010).

The theory makes three predictions relevant to our failure. First, a task with many interacting elements will overwhelm novices if all elements are presented at once. Second, learning from a representation that differs from the real task, such as a diagram instead of a device, requires learners to translate between the two, which adds load and may leave the schema tied to the representation. Third, a skill learned in calm conditions may fail when the real situation adds its own demands, such as a patient in pain, an alarm and a time of night when help is far away.

Applying the Theory to the Failure

A task with many interacting elements. A chest drainage system has at least seven elements a nurse must interpret together: the collection chamber, the water seal, the suction control, tidaling, bubbling, the patient's breathing and whether suction is ordered. Bubbling means one thing on suction and another on water seal. Tidaling means one thing when present and something else when it stops. The elements cannot be understood one at a time in isolation, which is exactly the condition under which novices are overloaded. Our current session presents all of them in the first fifteen minutes, on a diagram.

A representation unlike the task. The session teaches from a labeled diagram and tests with the same diagram. At the bedside, the device is turned sideways, partly hidden behind the bed frame, and the chambers are unlabeled. The schema new graduates build in class is a diagram schema. At 0300, they must translate from the diagram in memory to the device in front of them while also managing a patient, and working memory runs out.

Added demands at the bedside. The events above happened at night, during transport or while a patient was coughing or in pain. Each adds elements to working memory: the patient's distress, the transport team waiting, the alarm. A nurse whose chest drainage schema is still fragile has little capacity left. Clamping during transport is a telling error. It is a simple rule-like action that feels safe under pressure, the kind of response a person falls back on when the more complex judgment cannot be made.

What the Theory Says to Change

The theory suggests three changes to the session, each targeting one of the problems above.

Build the schema in parts, then as a whole. Instead of presenting all seven elements at once, the revised session teaches the water seal alone first, on the real device, until nurses can read tidaling and bubbling reliably. Suction and drainage recording are added only after that. Once the parts are secure, whole-task practice follows, with the nurse checking a complete system on a patient simulator. This sequence of part-task and whole-task practice is one of the design strategies recommended for complex skills in health professional education (van Merriënboer & Sweller, 2010).

Teach on the device, not the diagram. The diagram is removed from the session except as a one-page reference card. All practice uses a real drainage system positioned as it would be at the bedside, including below the bed and partly hidden.

Practice under added demand. Once the basic checks are secure, nurses practice with the simulator coughing, an alarm sounding and a transport scenario, so that they meet those demands while their educator is present to help.

Why Not Andragogy or Behaviorism

Andragogy, which emphasizes adults' self-direction, experience and need to know why they are learning (Knowles et al., 2015), would suggest making the session more relevant and learner-led. Our new graduates are motivated and already see the relevance of chest drainage. Their problem is not motivation. It is that they cannot yet process the task, which andragogy does not address.

Behaviorism would suggest drilling the correct responses with reinforcement until they are automatic. That would help with simple rules, such as not clamping during transport, but it would not build the understanding needed to interpret bubbling correctly in different situations, which is where most of the failures occur.

Cognitive load theory explains both the classroom success and the bedside failure, and it points to specific changes. That is the test a theory should pass in a brief like this one.

How the Change Will Be Tested

The revised session will run for the next two residency cohorts. The unit will track the same events as before: clamping without an order, unnecessary calls about expected bubbling and charge nurse reports of new nurses unsure what to check. Because the numbers are small, the comparison will be descriptive rather than statistical. I will also add a bedside check, two weeks after the session, in which a preceptor asks each new nurse to check a real patient's system aloud. If the theory is right, the bedside check will improve more than the written one, because the schema will now be built on the device rather than the diagram.

References

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.

van Merriënboer, J. J. G., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85-93. https://doi.org/10.1111/j.1365-2923.2009.03498.x