Authors

1. Montin, Liisa PhD RN
2. Koivisto, Jaana-Maija MNSc RN

Abstract

Review question/objective: What is the effectiveness of self-directed learning methods compared with other learning methods in nursing education?

Do self-directed learning methods improve the continuing education learning outcomes of nursing students' or registered nurses'?

Background: It is well known that the nursing workforce is aging and graduation of new nurses is insufficient to meet their global demand.1 Additionally, the population is aging; by 2050 there will be a greater number of older than younger people in the world.2 This means an increasing demand for health services.

The average nurse population ratio in Europe, the region with the highest ratios, is 10 times the average ratio in the lowest region. At a country level, for example in some Central African countries, the ratio varies from less than 10 nurses per 100,000 people, to more than 1000 nurses per 100,000 people in countries such as Norway and Finland.3 A nursing shortage, at the local, regional, national and global levels, has a negative impact on health care as it may lead to failure in maintaining or improving health care.4

Nurses are also changing jobs and leaving nursing. One reason for this is lack of access to continuing education.2 Nursing shortage is not limited to clinical practice. It also includes nursing faculty, who are needed to prepare current and future generations of nurses.2 The nursing education system is inadequate to supply the increased demand for nurses.1 The education-related issues also include a lack of qualified faculty and clinical sites.5,1

This context raises the question of whether nurses should take more responsibility for their own learning.6 Therefore, different learning methods are needed in order to fulfill the requirements of these demand issues in health care. It is important to support diverse and individual learning practices. They enable self-generated study, which emphasizes student responsibility of their learning and professional development. Thus, it is reasonable to ascertain whether there is any research evidence of the impact of self-directed learning methods.

Learning theories can be grouped into four main categories: behaviorism (e.g. Skinner's theory), cognitive (e.g. Lewin's approach, Ausubels' theory, Kolb's learning styles), humanistic (e.g. Rogers' and Mezirow's theory) and social (e.g. Vygotsky's and Bandura's theory) perspectives on learning. The focus of the theories or approaches vary from passive (behaviorist) to active learning (others).7 The concept of self-directed learning is based on active learning and the principles of adult education.8 In self-directed learning, the educator acts as a facilitator and identification of learning needs as well as learning objectives and evaluation of learning are important parts of the learning process.8,9,10

Self-directed learning can be defined in following ways. It is directed at one's self or under one's own control.11 Also it can be directed or guided by oneself, especially as an independent agent and learning can be regulated or conducted by oneself.12 Although previous literature indicates that there is no clear definition of the concept of self-directed learning, some consensus exists nevertheless. Self-directed learning is understood to be a form of study in which students are responsible for planning, implementing and evaluating their own work.14 In most definitions, there is also a perception that some personal control by the learner is needed during the learning process.9

However, the research has indicated that not all students are self-directed. Mature students who already had previous nursing experience have been found to have a preference for structured teaching. This preference is similar to traditional students.15 In some cases, mature students may be more self-directed if they have previous learning experience and therefore are more confident with their learning process.16

Research has suggested that self-directed learning is one of many teaching methods and before using it, educators must assess students' learning styles and learning skills in order to decide whether this learning method can be used.9 Independent or self-directed learning can be implemented in many ways, but the activity of the learner must be confirmed.9,10 It is important to find meaningful learning strategies and/or activities such as computer or internet-based,17,18 problem-based learning methods,19 or other traditional learning methods which can engage students in active learning. New learning environments, such as virtual learning, may help maintain today's students' interest in learning and provide valuable experiences that may enhance student engagement, promote participation and motivate self-directed learning.20 Possibilities of virtual pedagogy are recommended as being useful more and more frequently in nursing training.21,22

Self-directed or independent learning has been studied with different perspectives and methods, with some positive outcomes. Self-directed learning has been found to have many advantages. It increases students' options, self-confidence, independence, motivation and also the development of different skills for lifelong learning.9 It seems that many different educational solutions can be used in order to promote independent learning.23,19 Also, there exists moderate quality evidence which shows a modest improvement in the knowledge, but no difference in the skills or attitudes of health professional students when comparing self-directed learning and traditional learning methods.24 Still, there is no conclusion about the best method(s) to catch best learning outcomes. The purpose of this systematic review is to try to answer the question of the effectiveness of self-directed learning methods, for example skills, knowledge, attitude, competence and ability learning outcomes.