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Feature Article

Talking Out Loud

in Class

Utilizing Discussion as an Effective

Teaching Strategy With Adult Learners
Amy L. Hotler, MSN, RN

Staff development is an important role

of the school nurse, yet little is written
to assist the nurse in this role. Though
some obtain advanced degrees in
education, most school nurses are not
prepared for the staff development role
without further education in pedagogy,
teaching strategies, and evaluation
methods. This article presents
discussion as one of many active
teaching strategies that can engage
learners and promote critical thinking.
More work is needed in the area of
course design and implementation,
as well as additional research to help
identify the most effective teaching
strategies for school employees.
Keywords: staff development;
in-service training; discussion; adult
learning; school nurse role; lesson plans

ver the past decade, schools have

been increasingly mandated to
provide training for staff members
on topics such as relief of foreign
body airway obstruction, blood-borne
pathogens, and child abuse recognition
and reporting. Additionally, childcare
staff in Ohio are required to receive
training in communicable diseases, first
aid, and cardiopulmonary resuscitation
as part of a required (or totaling) 15
hours of staff development training each
year (Ohio Department of Education,

2009). School nurses are increasingly

called upon to present this content, and
NASN standards of practice support
this teaching role (American Nurses
Association, 2011).
Though some school nurses obtain
advanced degrees in education, they are
not usually prepared for the staff
development role without further
education in pedagogy, teaching
strategies, and evaluation methods. Many
rely on PowerPoint presentations in
lecture format instead of using more
engaging teaching strategies. Learning
principles of curriculum and course
development are a starting point to
developing the teacher role of the
school nurse. Choosing an effective
teaching strategy is a second important
aspect of course development. The
purpose of this article is to discuss
considerations for teaching adults and
explore discussion as an effective
strategy that will stimulate active
learning while engaging faculty and staff
in the process of critical thinking.
Though health education is frequently
cited within the scope of school nursing
practice, it is most often in the context
of the individual and classroom teaching
of students or as a resource for
classroom teachers, including providing
input into curriculum development
(Broussard, 2004). Proctor (2006) and

McHenry, Silver, and Wolfe (2006)

described faculty and in-service
education as a part of the health
teaching and health promotion standard
of practice for school nurses.

Adult Learning
With in-service programs being
focused on faculty and staff, it is
important to realize the difference
between learning styles of children and
adults. School nurses proficient in
classroom instruction with students will
need to consider the unique needs of
adult learners. There are several theories
about how adults learn, as well as
different domains of knowledge. Review
of adult learning theory is beyond the
scope of this article, though Mintor
(2011) summarized some important
assumptions regarding the teaching of
adults. He pointed out that the adult
learner brings a wealth of experience to
the learning environment, along with a
self-directed focus. Adults prefer to be
actively engaged in learning and prefer a
facilitator who is learner focused. They
have a great foundation on which to
build new information for their own use.
Additionally, it is important to consider
the many ways that adults learn. Various
dynamics influence learning, including
motivational factors, learning styles,
amount and type of professional

DOI: 10.1177/1942602X13488630
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2013 The Author(s)
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September 2013 | NASN School Nurse


experience, educational preparation for

their role, and the context of learning
(e.g., required vs. elective) (Sherwin,
2010; Wellman, 2009). Using a variety of
teaching strategies (in addition to
presentation style) is most likely to
support the various dynamics and
multiple learning styles of adults (Bain,
2004; Gross Davis, 2009; McKeachie &
Svinicki, 2011).
Blooms taxonomy is a way of
identifying and classifying various
domains of learning and cognitive levels.
Benjamin Bloom is credited with this
classification system, created in 1956 and
revised in 2001 (Erickson, Peters, &
Strommer, 2006). The taxonomy describes
cognitive, behavioral, and affective
domains. In the cognitive domain, the
learner is concerned with concepts
including understanding, reasoning, and
application of information. The behavioral
domain is related to learning specific
physical tasks or motor skills. Finally, the
affective domain is concerned with
developing values (McDonald, 2007;
Onega & Devers Barbero, 2010). For
example, in a staff in-service about
removal of a foreign object from an
airway, an instructor would want to
address the behavioral domain of
teaching, which would encompass the
motor skills necessary to perform
abdominal thrusts on a choking victim.
The cognitive domain might be addressed
in a communicable disease presentation
through helping learners develop a
prevention strategy by assimilating what
they have learned about the spread of
disease using a chain of infection model.
In a child abuse prevention course,
learners may be impacted in the affective
domain by learning to view perpetrators
of violence as individuals with poor
coping skills and a lack of support
systems, two characteristics associated
with those who abuse (Ohio Department
of Jobs and Family Services, 2007). This
could have far-reaching consequences by
inspiring participants to create an
environment of family support, which
could result in the prevention of abuse.
Further, all three domains might be
utilized for a single subject. Utilizing the
removal of a foreign body from an

airway example given above, the

cognitive and affective domains can be
secondary focuses. The instructor can
use the cognitive domain to help the
learner understand why abdominal
thrusts are effective. The affective
domain is utilized when the instructor
reminds students that in a choking
episode, the victim is typically
embarrassed and often seeks to retreat
to a restroom or other place out of site
of the remaining individuals. Helping the
adult learners relate to the past
embarrassment they have felt while
choking has the possibility of
strengthening the effectiveness of the
instruction, namely, to never let a
choking victim go off by themselves.
In regard to effective teaching
strategies, there are many that are
appropriate for adult learners. Some
examples include problem-based
learning, where a group works toward
the solution of a case study over a
matter of time, utilizing role plays,
electronic communication strategies, or
multimedia, to name a few (Bradshaw &
Lowenstein, 2011). Discussion is one
teaching strategy that has been found to
be particularly effective with adults.
Therefore, this strategy will be explored
for the remainder of the article.

Discussion Method
Discussion facilitates the adult learners
ability to use past experiences to build
new knowledge. Brookfield and Preskill
(2005) identified many benefits of
discussion, including helping learners
develop a tolerance for ambiguity and
diversity, as well as foster critical
thinking skills. The authors pointed out
the benefit of encouraging good
listening skills and improving
collaborative learning. They also asserted
that discussion helps students scrutinize
their assumptions by testing them out in
small group settings. This process,
according to the authors, increases
intellectual agility (p. 22).
Further, discussion requires a certain
amount of exposure to the topic at
hand. Ezzedeen (2008) asserted that
prior preparation boosts students
confidence and fosters a greater desire

to participate (p. 233). Because prereading isnt always possible prior to

in-service programs, its important to
plan how to provide some background
information before the opening of a
discussion. This could be in the form of
a short reading assignment on the day of
the meeting or the presentation of a
short video clip. It might also be
effective to invite those in the group
with experience to share their
knowledge or expertise, enriching the
knowledge base of the group.
When choosing discussion as a
teaching strategy, planning for seating is
especially important. Arranging the room
in a circle or, for larger groups, a
horseshoe can eliminate obstacles such
as desks and other participants by
creating a seating arrangement where all
participants can see one another
(Edmunds & Brown, 2010; Ezzedeen,
2008). Arranging the space so that the
facilitator is not at the perceived front of
the classroom will encourage
participants to talk with one another
rather than dialoguing with the instructor
(Gross Davis, 2009).
Discussion is more productive and
effective if ground rules are established
at the beginning. According to Landis
(2011), when people feel safe, listened
to and understood, their performance is
enhanced (p. 88). Ground rules
establish an atmosphere where
participants are respected (Brookfield &
Preskill, 2005; McCann, Johannessen,
Kahn, & Flanagan, 2006). Bain (2004)
added that an environment where
learners can try, fail, and learn by their
mistakes adds to a learners sense of
safety. Participants can assist with the
development of ground rules at the
beginning of the in-service, and these
can be written on a dry erase board or
newsprint for ease of reference
throughout the program.
Getting a discussion started can be
challenging for several reasons.
Sometimes participants have developed
passive learning habits from past lecturestyle presentations. Others may fear
criticism, believing that the facilitator is
looking for a specific answer (McKeachie
& Svinicki, 2011). Still others may avoid

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participating in discussions for cultural

reasons (Gross Davis, 2009). As shown
in Table 1, these obstacles can be
minimized by talking with staff about
the method of instruction, detailing the
value of discussion, creating ground
rules, and giving tips for participating in
discussion (Erickson et al., 2006; Gross
Davis, 2009). Facilitators can model good
listening techniques, keeping an open
mind and giving encouragement to
others. This creates a safe environment,
conducive to effective and meaningful
There are various creative grouping
ideas that can keep a discussion lively
and learners engaged. Though this is not
an exhaustive list, several will be
discussed here. Brookfield and Preskill
(2005) presented many of the
techniques, including snowballing (also
known as pyramid), jigsaws or crossover
groups, buzz groups, and newsprint
In snowballing or pyramid, a
question is posed to pairs of participants
and they begin by exploring the given
topic. After a designated period of time,
the pair is combined with a second pair
to make a group of four and the
discussion continues, combining the
points of view of each twosome. The
process continues in the same manner,
doubling the group every few minutes.
Edmunds and Brown (2010) suggested
that beyond groups of four, a facilitator
should add more challenge to the topic
to avoid boredom. Gross Davis (2009)
added an interesting twist by increasing
the complexity of tasks at each group
doubling. For example, during the first
round, group members share their ideas,
during the second round, the larger
groups identify common patterns among
the ideas, and during the third round,
the still-larger groups develop guidelines,
principles, or action plans (p. 208).
Jigsaws, also known as crossover
groups, are useful in topics with many
different subthemes. In the first round,
group members are formed that explore
one of the many aspects of the topic. In
a subsequent round, group members are
reconfigured so that one member from
each subgroup becomes the expert on

Table 1. Tips for Facilitating Discussion

Increase Participation

Keep the Discussion Going

Get to know the participants

Use nonverbal cues (nodding, smiling, eye


Create a safe environment through

establishment of ground rules

Draw students in: Do you agree or


Arrange seating to promote discussion: All

participants face one another

Encourage shy students

Spark discussion with a video clip,

controversy, anecdote, etc.

Discourage monopolizers: Thank them and

ask for others to add to their comments

Vary the facilitators position away from the

perceived front of the classroom to avoid
the single dialogue with facilitator

Tactfully correct wrong answers

Periodically arrange participants in smaller


Ask open ended questions

Allow periods of silence to create clarity

among participants

Ask questions with many possible answers

Do not answer your own questions

Ask general questions with no wrong

answer: How do you feel about this?

Model active listening and courteous


Limit facilitator comments

Creative grouping: snowball, jigsaw, buzz

groups, etc.

Mediate differences

the topic of the first round. The experts

then share what they gleaned from
round one. This technique is a quick
way for group members to learn many
different facets of a problem in a short
amount of time. For instance, in a class
on the topic of child abuse prevention
and recognition, three groups would
explore the characteristics of abusers,
characteristics of the abused, and
physical signs of child abuse,
respectively. Subsequently, the
participants are regrouped so that there
is one expert from each subgroup. Each
topic expert takes a turn leading the
discussion, sharing key concepts with
the rest of the group. When the process
concludes, all members are experts on
each of the distinct topics.
Buzz groups can be relaxed or
structured. In relaxed buzz groups, small
groups come together to discuss a topic.
There are no particular questions to be
answered or concepts to be explored.
The only requirement is that members
remain focused on the topic at hand.

Relaxed buzz groups could be suitable

ice breakers and a great way to
introduce a topic for discussion. Because
the requirements are limited, there is no
pressure in the dialogue. Those who are
less prepared can still be a part of the
conversation and competition is limited.
According to Edmunds and Brown
(2010), the facilitator is not usually
involved in the brief discussions of the
buzz group.
Structured buzz groups are given an
agenda to follow and are expected to
come up with answers to specific
questions. Brookfield and Preskill (2005)
suggested allowing some flexibility and
choice in answering questions so that
spontaneous exploration of the topic can
still take place. This way, if the group
wants to explore a compelling facet of
the topic, freedom allows them to stray
from the suggested direction proposed
by the given agenda. The authors also
suggested maintaining group sizes of
four to five participants so that
discussion is more manageable.

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Brookfield and Preskill (2005) also

described a technique for reporting
discussions back to larger groups, where
a group summarizes discussion results on
newsprint or a chalk board. Once the
group discussion is recorded, individuals
can stroll about, looking at the responses
of other groups and comparing them to
their own groups perspective.
Participants are encouraged to look for
themes and contradictions that can spur
continued discussion. The authors
included a variation on this technique,
where group members rotate to the next
newsprint and continue their discussion
based on remarks made by the previous
group. Rotations continue until each
group has had a chance to respond to
each set of written responses.

Though responsibilities for staff training
are increasing, not much is written
addressing the role of the school nurse
in staff development. This article has
highlighted important considerations
when planning for adult learning,
suggesting discussion as an effective
teaching strategy to support active
learning and engagement of faculty and
staff. Several challenges of the discussion
technique have been presented,
including strategies to overcome or limit
these obstacles.
The educator role of the school nurse
is varied and expansive. Effective
teaching strategies for staff are only one
piece of the puzzle. More work is
needed in the area of course design and
implementation. Research would help
identify the most effective teaching
strategies to employ with staff members.
By following a systematic plan of course
development, school nurses can provide
high quality faculty and staff education,
making an important contribution to
quality schools.

The author wishes to thank Heather
Janiszewski Goodin, PhD, RN, for her

support, encouragement, and contagious

enthusiasm, as well as thoughtful review
of earlier drafts of this work.

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Amy L. Hotler, MSN, RN

School Nurse
Columbus City Schools
Columbus, OH
Amy is a school nurse, serving
the pre-kindergarten children and
families of the Columbus City School
District in Columbus, Ohio. She
also provides staff development
opportunities in the district for the
Department of Early Childhood