Jerome Bruner teaching presentation

Jerome Bruner’s Spiraling Curriculum in Action:
Fluid and Electrolytes to First Semester Nursing Students

Jerome Bruner is an influential cognitive psychologist who was born in
1915 and is still living today at 99 years of age. Bruner has focused his
work on perception, cognition, and cultural and narrative experiences.
His work has been built around his close affiliation with
the constructivism learning theory. Two major components of Bruner’s
learning theory are the three modes of representation and a spiraling
curriculum. My presentation focused on the utilization of the spiraling
curriculum technique in first semester nursing students.

According to the theory of the spiraling curriculum, anyone can be
taught anything depending on the how the educator presents the
material. Bruner also, believed that students move through different
stages of representation: enactive, iconic, and symbolic (Johnston,
2012). In other words, a student will continue to revisit a topic or subject
matter repeatedly. With each encounter of the content, the complexity
will increase and therefore the learner will build depth of understanding
while expanding on a foundation of previous knowledge (McLeod,
2008). Some of the benefits of the spiral curriculum are reinforcement of
content every time the student reviews the subject matter, promotion of a
systematic progression of learning from simple to complex, and students
are encouraged to apply previous knowledge gained throughout future
course work. This type of curriculum involves interactive and unlimited
approaches to instruction while fostering student curiosity regarding
acquisition of knowledge. In essence, the components of spiral
curriculum are to enhanced student learning outcomes (Johnston, 2012).

With this background knowledge, I developed a discussion with first
semester junior nursing students on fluid and electrolytes. The expected
learning outcomes for this class were:

1. The student will be able to recall information regarding basic
chemistry and anatomy/physiology facts that were learned prior to
entering nursing school such as
a. What is an electrolyte?
b. What is fluid concentration?
c. Where is the majority of the fluid in the body stored?
d. What is the difference between an anion and a cation?

2. The student will be able to take this previously learned information
and make connections to nursing care of patients with basic fluid
and electrolyte imbalances such as with dehydration and edema.

3. The student will gain a broader depth of understanding of the
concept of fluid and electrolyte imbalance related to nursing.

The teaching objectives were:

1. The teacher will clearly explain the concept of fluid and electrolyte
imbalance as it pertains to nursing care of patients with conditions
of dehydration and fluid volume excess.

2. The teacher will reate an environment conducive to discussion,
question and answer.

3. The teacher will facilitate the student’s application of new and
previously learned information to patient care scenarios with a case
study.

To begin the class, I handed out a quiz that evaluated the student’s current level of
recall and understanding from knowledge gained through prerequisite nursing
courses. (Enactive representation)

What do you know about fluid & electrolytes from Chemistry and Anatomy
& Physiology?

1. Osmolality= ___________________ concentration
2. Degree of acidity = ______________________
3. The majority of water in the body is

a. Intracellular
b. Extracellular
4. Extracellular fluid has three locations. Name these three locations.
a. ________________________________
b. ________________________________
c. ________________________________
5. Name 5 of the most commonly found electrolytes in the body.
6. ______________________ are positively charged ions.
7. ______________________ are negatively charged ions.
8. Movement of ions against an osmotic pressure to an area of higher pressure
is
a. Diffusion
b. Osmosis
c. Filtration
d. Active transport
9. Passive movement of electrolytes down the concentration gradient (from
higher to lower concentration is:
a. Diffusion
b. Osmosis
c. Filtration
d. Active transport
10.What is the difference between sensible and insensible water loss?

Below are some of the slides from the presentation that the students had before and
during class. These slides provide another vantage point to view the concept

(Potter, 2013)

(Potter, 2013)

After discussing the information above, it was time to start making some
applications to nursing!
The first question I posed was: (iconic representation)

What are some patient risk factors leading to impaired
fluid and electrolyte balances?

I received answers such as:
“Vomiting”
“Diarrhea”
“Dehydration”
“Bleeding”
While progressing through this content I facilitated the student’s concept
development while building on the foundation of their previous
knowledge learned, creating a spiraling effect. In essence, the class
looked at fluid and electrolytes from several different perspectives
including:

 Risk factors
 Assessment
 Nursing interventions

I then posed the question below for them to consider and answer, which
took them back to their basic level of understanding but had them apply
their knowledge to a patient scenario. (Iconic representation)

A patient is diaphoretic and has an oral temperature of 104° F. These
are classic signs of:

A. ADH deficit.
B. Extracellular fluid loss.
C. Insensible water loss.
D. Sensible water loss.

The majority of the students answered this question correctly, which
showed me that they were able to apply basic knowledge to patient care
scenarios and therefore I believed we were ready progress to a more
complex application of fluid and electrolytes.

Next, I presented fluid and electrolyte imbalances from the perspective
of intracellular and extracellular imbalances. We then discussed how
these variations might appear in a patient with a fluid and electrolyte
imbalance. I used some of the following slides to demonstrate the
concept in greater depth.

(Potter, 2013)

(Potter, 2013)

Next, we discussed the following specific electrolytes, the normal ranges for each,
and their role in fluid and electrolyte imbalances:

 K+
 Na+
 Ca++
 Mg++

After discussion of these electrolytes, I guided the student’s in applying their
knowledge to the nursing process. The students applied information that had been
previously learned and information that was learned/discovered during the class
period to the nursing process. In other words, they were asked to identify potential
nursing diagnosis, goals, and interventions as well as and then how they would
evaluate a patient with a fluid and electrolyte imbalance.

Finally, the students worked in groups on a case study involving a patient with a
history of nausea and vomiting that had led to a fluid and electrolyte imbalance.
Then there was a class discussion about the case study, which clearly demonstrated
that the students had gained a broader depth of understanding. The students were
able to identify the source of the electrolyte imbalance and develop nursing
interventions that would work towards correcting the imbalance. They were also
able to discuss applicable patient teaching strategies that would be effective in this
scenario. The students expressed satisfaction with the progression of the class and
believed that the case study at the end was appropriate to tie everything together.
Giving the students the opportunity to provide feedback is an integral part of
effective instruction (Qais, 2007). (Symbolic representation)

Reflection

Fluid and electrolytes is a difficult concept to grasp for many nursing students,
especially first semester nursing students. I think this class session went really
well. By starting out with the expectation that they were going to be applying
previous knowledge they had learned, the focus was placed more on the student
than the faculty, which encouraged them to be participants that are more active.
As I began to help them build on this knowledge and make connections, I focused
on more simple applications and then reinforced them in different ways (spiraling).
I used graphic representations, group discussion, NCLEX style questions, nursing
process, and a case study. Each of these applications built on the student's
knowledge and stretched their learning. Throughout the process of studying and
implementing Bruner’s spiraling curriculum, I have found that I have become a
much bigger proponent of it. I believe that it is just as applicable in nursing
education as it is in young children.

References

Driscoll, M. (2005). Psychology of Learning for Instruction (3rd end). Boston:
Pearson.

Johnson, H. (2012, March). Spiral Curriculum. Retrieved 2015, from Education
Partnerships, Inc: Research into practice: www.educationpartners.org

McLeod, S. A. (2008). Bruner. Retrieved from
www.simplypsychology.org/bruner.html

Potter, P. P. (2013). Fundamentals of Nursing (8th ed.). St. Louis, Missouri:
Elsevier.

Qais, F. B. (2007). Redefining the classroom culture through instructional design.
1st Annual International Malaysian Educational Technology Convention,
(pp. 1-9). Johor Baru.