Chapter II REVIEW OF RELATED LITERATURE AND STUDIES This chapter presents the review of related literature and related

studies that provides the basis in conducting the study. Conceptual Framework There are different terms being associated to conceptual framework such as theory, models and schemes, but the primary distinction between them is the level of abstraction. Conceptual frameworks are structured from a set of broad ideas and theories that help a researcher to properly identify the problem they are looking at, frame their questions and find suitable literature (Smyth, 2004). It is a tool used by the researcher to guide ones data collection and analysis. According to sociologists Haralambos and Holborn, a conceptual framework enables the researcher to find links between the existing literature and his own research goals. Students satisfaction refers to the fulfillment of his/her desire or need in terms of the degree, extent and significance of learning. In order to achieve students satisfaction, there should be a facilitator, which is in Nursing, a clinical instructor. One of the most valuable things a teacher can do is to help students prepare for a lifelong learning with the help or use of teaching strategies. In a clinical learning environment, instructors work with students and faculty to ensure the continued education of aspiring nurses, health practitioners and service providers.

CLINICAL INSTRUCTORS TEACHING

EFFECTIVE USE OF TEACHING STRATEGIES

TEACHING STRATEGY INDICATORS SKILLS KNOWLEDGE ATTITUDE

LEVEL OF SATISFACTION

Figure 2. Conceptual Framework

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It requires instructors to have a love of the profession for which they provide instruction along with an appreciation of academics. clinical instructors facilitate new learning methods for future professionals. The diagram in figure 2 depicts the level of students satisfaction as attaining professional competence as they go through the different strategies used by a teacher. It presented how clinical instructors teaching facilitates students learning by possessing the 3 components such as the skills, knowledge and attitude. It presented ways towards an effective teaching and satisfaction. Students satisfaction is an important indicator for the delivery of quality education made available by teaching-learning process in terms of the teaching strategies and methods applied by the clinical instructor. Review of Related Literature Nursing and the Education Process The education process is a systematic, sequential, planned course of action with teaching and learning as its two major interdependent functions and the teacher and learner as the key players involved (Bastable, 2003). He compared education process and the Nursing process according to their similarities and differences. They both consist the basic elements of assessment, planning, implementation, and evaluation. Both are methods for monitoring and judging the overall quality of Nursing interventions based on objective data and scientific criteria.

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They differ as Nursing process focuses on planning and implementation of care based on assessment and diagnosis of the clients physical and psychosocial needs while the education process identifies instructional content and methods based on an assessment of the clients learning needs, readiness to learn, and learning styles. Nursing processes base their outcomes when the physical and psychosocial needs of the client are met while education processes base the outcomes when changes in skills, knowledge, and attitudes occur. Education is an interactive process of imparting knowledge through sharing, explaining, clarifying, and synthesizing the substantive content of the learning process in order to arrive at a positive judgment and well-developed wisdom and behavior (Kozier, 2004). It is likewise an application of several teaching and learning principles which comprise a body of knowledge and research findings ultimately to result in the formation of expected behavior of an individual. The teaching-learning process primarily involves the teacher, the learner and the subject matter. The success of this process rests mainly on the shoulders of the teacher. As Pohl (1988) would say that Teaching is an integral part of the Nursing process and the nurse is teaching whether directly or indirectly, in every contact with potential learners. The nurse is teaching through what is being done and through attitudes expressed either verbally or nonverbally to the learners (Castro, 2009). Teaching
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Teaching, in traditional usage, simply means giving instruction. It is pursued as a lifetime career with passion for the purpose of offering enduring love and care, to share their knowledge and developed skills to equip the citizenry towards literacy and enlightenment. According to educators, teaching is an aggregate of organized instructional methodologies aimed at achieving a desired learning objective. Some of its objectives includes: acquisition of knowledge and information, development of skills and cultivation of values and attitudes. The ultimate objective is to enable students to learn and sustain continued learning for self- growth and development. The whole process which consists of teaching that (knowledge), teaching how (skills) and teaching to be (attitude) is pursued through systematically planned teaching methodologies and procedures (Salandanan, 2004). According to him, with learners at the center, teaching also serves as the principal means of awakening and nurturing the students interest and learning potentials with an end view of inducing self- learning and self- reliance. A heightened consideration of their personalities, character and capacities are evident in the manifold teaching chores. He further said that teaching is also acknowledged as an art and science. It is an art because it calls for the use of talent, resourcefulness and creativity. It is mainly a creative expression of ones intellectual and emotional qualities that are essential in promoting learning. It is also a science for it involves a repertoire of techniques, procedures, strategies, discoveries, and implementation. It is conducted in a carefully sequenced methodology wherein learning activities are
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planned and organized in a step-by-step manner without much regard for the least signs of difficulties, negative attitudes and indifference among the students. As for Lardizabal (2004), teaching is also defined as a multi- faceted activity because it involves a wide range of human interactions with students and other variables in the learning environment; in short, it is an active learning process. She also enumerated some of the principles for an effective teaching such as: focus on the learner, provide a supportive learning environment, teach the whole class, provide structure and signposts, help learners find their own ways of learning, use the book as a resource, dont under teach, know ones principles and teach reflectively. With all of these principles, it could promote an active and effective teaching. Nurse as an Educator According to Alegado (1996), the teacher is at the forefront in educating and training the learner under his direct change towards what is good, true, and beautiful. Hence, the teacher should possess the necessary attitude and competencies to effectively create a productive atmosphere related to the teaching-learning process. He also added that Good teachers know how to help people become conscious of their own values, to examine these values that are more satisfying to society. Based on these perspectives, one can conclude that aside from the usual goal of learning, which is the acquisition of the necessary skills, knowledge, and attitudes, the incorporation of values in the curriculum is also a must.

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Wagner and Ash (1998) explained that The role of the educator is not primarily to teach, but to promote learning and to provide for an environment conducive to learning to create the teachable moment rather than just waiting for it to happen. Studies have shown that the vital role of the teacher is motivating students to learn, and inspiring them to get out of their comfort zones to stretch and develop 98% portion of their brain which is still untapped and unused. Classroom Management Classroom management refers to the operation and control of classroom activities, the mechanical aspects of handling classes such as classroom policies and regulations for seating arrangement, attendance, handling instructional materials and equipment and discipline during the class period. The teacher who can manage the classroom well provides students with opportunities for mental growth and development. (Gregorio, 2004). Qualities of an Effective Teacher The teachers competence in terms of knowledge and skills possessed significantly contribute to the accepted standards and ideals of the teaching profession. As a professional, a teacher is expected to be knowledgeable about the subject she is supposed to teach. She must possess not only substantial knowledge but deeper and more advanced in order to be able to teach with confidence and accuracy. She could include what the students are supposed to know about the subject including what they want to know (Salandanan, 2004).
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Likewise, the teacher must be knowledgeable and skilled in employing a wide repertoire of teaching methods, procedures and strategies that can insure the consistent and continued search for knowledge and new information. If students find difficulties in following the systematic procedures she can easily revise or think of alternative solutions, thus avert wastage of time, effort and materials. Employing time-tested and experience-proven methodologies is a mark of an updated and progressive teacher. Knowledge and skill in implementing appropriate teaching methodologies and procedures are the winning

qualifications of a teacher. With it goes the ability to improvise simple tools, construct audiovisual devices and execute new ways of doing things - truly a facilitative and innovative adeptness that are much needed. Expertise in operating equipment such as projectors, computers, measuring machines, timekeeping devices and other new technologies are critical requirements in todays classrooms to accelerate performance of learning activities. Students Learning Salandanan (2004) stated that the students capacity to learn varies, thus students can be classified into fast, average and slow learners. Some are high, moderate or slow achievers. Tactful teachers know when and how to adjust their questions during discussions or require reinforcement activities that will enable each of them to be at pace with the rest. The high performer tackles the more difficult learning tasks, the not- so difficult for others. Encouragement and guidance will enable them to achieve the lesson objectives. Learning is enjoyed

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at the same time. According to researches, each person has a distinct and often idiosyncratic style and preference for learning and remembering (Read, 1997). Teaching Methods According to Bustos (2004), method forms the bridge between the child and the subject matter. This bridge enables the child to get the other end. Method makes learning easier. Todays newer and broader concept of method stresses on the why rather than how. Reforms are being made advocating for a more and more teaching strategies that are inquiry and problem oriented in order to develop the ability to think, rationalize and make proper decisions of the students. There are already different teaching methods evolving such as: inductive method, also known as the discovery method, the child learns chiefly through own activity. He observes the cases, compares them, analyzes them and draws his own conclusion. The deductive method is reverse with the inductive; it is a process of solving a problem or overcoming a difficulty by applying to the problem already formed. The problem method gives direction to a discussion and prevents wandering off from the topic. It stimulates reflective thinking and furnishes a guide for organizing ideas. It contributes to the development of personality. The child develops independence and initiative. Many things in life are learned through imitation. In the hands of a very competent teacher who is a good model himself, the demonstration method can be very effective. The expository method is also called the explaining method in which it is a good way to learn for those who are ear minded. It is the best way to
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get appreciation as the teacher usually can interpret better than the students. Lastly the lecture method, it held an important place in the teacher- centered traditional school. Bossing (2004) defines lecture as a teaching procedure for clarifying or explaining a major idea cast in the form of a question or problem. Traditional methods are still used today as enumerated above; these methods are also called as time- tested methods, which are found to be effective. In line with this, there was one study conducted to compare the effectiveness of two instructional methodologies in teaching basic Nursing skills in the learning laboratory. One methodology used an interactive, studentcentered focus; the other used traditional lectures and demonstrations. A repeated measures, experimental design was employed, supplemented by qualitative and questionnaire data. There were no significant differences between the groups' pretest to posttest cognitive gains, although there were cognitive gains for both groups. The groups also were similar in their ability to demonstrate the basic skills correctly in the learning laboratory. However, results showed significant differences by group in student satisfaction, with the interactive, student-centered group more satisfied with their learning methodology than the traditional group (http://www.nlnjournal.org). Teaching Strategies Strategy is a specific plan of action, a tactic or a scheme which the teacher devises to achieve goals and learning objectives. It is a manner by which such a plan or scheme is developed and implemented. Teaching strategy is the
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overall plan for a learning experience which makes use of one or more methods of teaching and includes content and process to achieve the desired outcomes (Rothwell and Kazanas, 1992). They added that instructional methods are the techniques and approaches used by the teacher to make the learner understand the content to be learned. Methods are a way, an approach, or a process to communicate information. Following are the needed preparations for an effective presentation of a lesson. At the outset the objectives are clearly stated in behavioral terms to insure ease and accuracy in assessing the achievement through the activities undertaken. The instructional materials to be needed, the equipment to be used, such as projectors, television set and computers are scheduled. Audiovisual devices such as recorders, tapes, diskettes, films and slides are prepared and arranged in advance. Specimens and real objects are selected for fast distribution, including possible substitutions as needed. The lesson is planned according to the sequence in the syllabus being followed. The preliminary activities may start with a motivation, a review of the past lesson, or a slide presentation to set the right mood for the presentation of the days lesson. The lesson proper follows a teaching methodology which could be in the form of a class discussion, demonstration or experimentation. The choice of what strategy or technique to employ would depend on the subject matter, the objectives desired and the background knowledge of the students (Salandanan, 2004). There are a variety of teaching strategies that instructors can use to improve student learning. Active Learning is anything that students do in a
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classroom other than merely passively listening to an instructor's lecture. Research shows that active learning improves students' understanding and retention of information and can be very effective in developing higher order cognitive skills such as problem solving and critical thinking. Cooperative and collaborative learning are instructional approaches in which students work together in small groups to accomplish a common learning goal. They need to be carefully planned and executed, but they don't require permanently formed groups. Engaging students in discussion deepens their learning and motivation by propelling them to develop their own views and hear their own voices. A good environment for interaction is the first step in encouraging students to talk. Experiential learning is an approach to education that focuses on "learning by doing," on the participant's subjective experience. The role of the educator is to design "direct experiences" that include preparatory and reflective exercises. Games, experiments and simulations can be rich learning environments for students. Students today have grown up playing games and using interactive tools such as the Internet, phones, and other appliances. Games and

simulations enable students to solve real-world problems in a safe environment and enjoy themselves while doing so. Using humor in the classroom can enhance student learning by improving understanding and retention. LearnerCentered teaching means the student is at the center of learning. The student assumes the responsibility for learning while the instructor is responsible for facilitating the learning. Thus, the power in the classroom shifts to the

student. Lectures are the way most instructors today learned in classes.
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However, with todays students, lecturing does not hold their attention for very long, even though they are a means of conveying information to students. Communication with students becomes extremely important. Problem-based Learning (PBL) is an instructional method that challenges students to learn," working in groups to seek solutions to real world problems. Case studies present students with real-life problems and enable them to apply what they have learned in the classroom to real life situations. Cases also encourage students to develop logical problem solving skills and, if used in teams, group interaction skills. Students define problems, analyze possible alternative actions and provide solutions with a rationale for their choices. In most cases both faculty members are present during each class and can provide different styles of interaction as well as different viewpoints (http://pedagogy.merlot.org). Discussion is the most traditional method associated with teaching in which the teacher simply conveys the knowledge to the students in a one-way channel of communication. It can be an efficient means of introducing learners to new topics. It is used to integrate and synthesize a large body of knowledge from several fields or sources and used to clarify difficult concepts (Tan, 2009). The teacher acts as the discussion leader. She can create a conducive atmosphere that can enhance higher order thinking skills by allowing free discussions. Greater interaction in the classroom is facilitated. A lecture methodology lessens student involvement. Small group discussions encourage focused thinking about a particular topic, resulting in high level arguments (Salandanan, 2001).
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The teacher initiates the learning process by asking students about their insights and ideas regarding subject matter. In this method, the teacher asks the students what they understand of the subject matter to determine what they have already learned and what they need to learn. Questioning is integral to teaching that is often taken for granted. Its use places learners in an active role. It can be used to assess students competencies and baseline knowledge to find out what a group already knows about the subject in order to review its contents. Questioning can increase motivation of learners as it brings about eagerness to learn answers to questions asked (Tan, 2009). Simulations are practical exercises for the students representing controlled manipulation of reality. These are exercises which learners engage in to know the real world without the risks of harm or injury and make learning enjoyable. These intend to help learners in decision-making and problem-solving, develop human interaction abilities and learn psychomotor skills in a safe and controlled setting. They can be used to achieve the various learning objectives. They can also be used to evaluate students learning and competence. The four types of simulation techniques are simulation exercise, simulation game, role playing, and case study (Tan, 2009). Mary Elizabeth (2011) emphasized that an oral report is an opportunity for students to practice their speaking skills, but other skills may come into play as well. There are presentation skills, such as making eye contact with ones audience, listening skills of a question and answer session, and the skill of anticipating how to present something in a way that will be understandable as
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well as appealing to ones particular audience. It also allows clinical instructors to gauge students understanding of a given topic and the ability to formulate that understanding into oral discourse (Volle, 2005). According to Clark (2008), problem-based learning is an approach to learning that involves confronting students with real life problems which they are meant to solve on their own. It provides stimulus for critical thinking and selftaught content. It is based on the premise that students working together in small groups, will analyze a case, identify their own needs for information and solve problems. Teaching Devices Using audiovisual aids is a traditional method that can reinforce teaching and learning. It is used as a supplement to a lecture, as a prelude to discussion, or a part of questioning strategy (Clark, 2008). When used appropriately, audiovisuals can greatly enhance teaching and add to students interest and facilitates understanding of the subject matter in the classroom. When not used appropriately, these simply become time fillers and entertainers which make learning insufficient or difficult. Types of traditional audiovisual devices include: Books, Hand-outs, Chalkboards, Overhead Projector, LCD Projector, Pictures, and Films. Audiovisual aids are instructional devices, which involve the use of the sense of sight and hearing. They can help and make ideas and concepts clear. Through these instructional aids, learning can be raised from verbalism to true understanding. It can also make learning interesting and vivid (Garcia, 2005).
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Textbook summarizes a great deal of pertinent information which enables the students to take home in convenient form most of the materials they need to learn for the course. It also provides a common resource for all the students to follow as well as for the teacher to have reference of ideas regarding the organization of information and activities. It already includes pictures, graphs, maps and other illustrative materials which facilitate understanding as well as other teaching aids, such as summaries and review questions (Aquino, 2003). The chalkboard is perhaps the oldest and most traditional piece of equipment found in the classroom, next to the textbook. It is the most widely used instructional aid. The chalkboard can be used for displaying pictures, important clippings, drawings, sketches and diagrams to help illustrate points of lessons, projecting films, and other materials listing suggestions or items out of problems and evaluating procedures and answers. The boards stimulate the student creativity and interest, promote the student participation in the learning activity, and make the room more cheerful and student- oriented (Aquino, 2003). Overhead projector projects images of transparencies on a screen wall or chalkboard. Because the machine is light in weight and portable, the OHP is convenient to use. It has become standard equipment in many classroom functions (Boiser, 2000). Film is the most influential educational medium for transmitting ideas and persuading an audience to a point of view. Film is both interesting and motivating for the students. A good film may be made expressly for educational purposes. A

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movie is particularly useful for sowing processes in which motion is involved or in which slow motion can be used (Aquino, 2003). Students Satisfaction Askar (2008), defined satisfaction as being a consequence of the expectations and experiences of the subject and/or course. Student satisfaction is one of the key factors for the success of the programs. Teacher performance is seen as only one of a number of antecedents of satisfaction. It is seen as contributing only when students perceive that teacher performance has dropped below a critical level or when teacher performance surpasses student expectations. That is, the performance of the teacher will reduce satisfaction when student feel that they are not being given enough information on how to pass the subject but will only increase satisfaction when his/her performance stimulates students well beyond personal, arbitrary standards of "interesting teaching". The level of students satisfaction is attaining professional competence as they go through the different strategies used by a teacher. It is how clinical instructors teaching facilitates students learning by satisfying its 3 components such as the skills, knowledge and attitude. It presented ways towards an effective teaching and satisfaction (Markham and Hagan, 2007). Related Studies Learning style is an individual difference that is most related to a learners preferences. These preferences are varied and can be adapted by the learner to adjust to divergent teaching and instructional settings as well as accommodated
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by teachers in their style of presentation. An implicit instructional goal in applying learning style research is to match a learners preferences to the type of instruction to improve the learners satisfaction and other outcomes such as performance. The recent research literature provides some support for the empirical nature of this relationship, especially when studied as determinant and outcome in the context of instructional setting. In a study of student perceived learning outcomes and satisfaction, a primarily visual and read/write learning style was a significant predictor of learner satisfaction in an online mode of course delivery. Of added relevance was that the results also indicated that learner satisfaction was a significant predictor of learning outcomes. Just as there are many types of learner preferences, there are many distinct models by which these preferences are understood and assessed. During several years of using and discussing the Felder and Soloman LSI in graduate research, many students claimed that they should be rated differently by this instrument in the visual side of the visual-verbal dimension. This was not only due to their preference for pictorial or diagrammatic representation of information, but also because they consider written text as being more visual than verbal. They interpreted the visual-verbal dichotomy as being equivalent to the corresponding actions of being seen or heard. This view contrasts Felder and Solomans description of this distinction: Visual learners remember best what they seepictures, diagrams, flow charts, time lines, films, and demonstrations. Verbal learners get more out of wordswritten and spoken explanations. Nonetheless, many of these students intuitively extend Felders concept of
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visual learners remember what they see to the presence of written Information, including formatted text found on Web pages (Henry, 2008).

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