Er-Huan Han,Yan Zhang,Jian-Ge Zhang,Bei-Lei Lin

School of Nursing,Zhengzhou University,Zhengzhou,Henan 450001,China

Review Article

Advances in the application of action learning in nursing practice☆

Er-Huan Han,Yan Zhang*,Jian-Ge Zhang,Bei-Lei Lin

School of Nursing,Zhengzhou University,Zhengzhou,Henan 450001,China

A R T I C L E I N F O

Article history:

Received 19 June 2015

Received in revised form

14 December 2015

Accepted 17 June 2016

Available online 15 September 2016

Action learning

Nursing practice

Reflexivity

Cooperativeness

Subjectivity

In this paper,we elucidate the concept and characteristics of action learning as well as summarize the reflexivity,cooperativeness,and subjectivity of this approach.Furthermore,we describe the effects and limitations of action learning when applied in nursing management,nursing education,and clinical practice,among various fields.

©2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1.Introduction

Action learning(AL)is a learning approach widely used in recent years that organizes learning groups by tightly focusing on specific learning activities.Group members learn through reflective action, thereby improving their learning capabilities to solve,and manage problems.Thus far,AL has been extensively used in multiple disciplines,and the trend of its application in nursing practice has also been enhanced.To further analyze the application of AL,this paper reviews the research advances regarding this learning approach in nursing practice.

2.Concept and characteristics of AL

2.1.Concept of AL

AL is a process of continuous reflection and learning that is supported by colleagues,with the goal of completing the intended work.1This concept was formally put forwardby Professor Reginald Revans in the United Kingdom,through his book“Developing Effective Managers”published in the 1970s.As such,Revans was later known as the“Father of Action Learning”.He explained thatthe general form of AL used the following formula:“L=P+Q”, where L represents learning,P represents programmed knowledge, and Q represents questioning insight.Revans believed that the acquisition of knowledge in AL not only relied on the regeneration of programmed knowledge but also that it is more important to ask questions and solve problems in specific actions to reconstruct the experience.2The core of AL is to take practical problems as the theme of learning and emphasize learning in action as well as action in learning:namely,the integration of learning and its application as well as a combination of knowledge and action.3

2.2.Characteristics of AL

2.2.1.Reflectivity

As required by AL,group members continue to reflect on the problems encountered and then cope appropriately to complete the intended work target.Thus,reflectivity is the primary characteristic of AL.Like the view proposed by Li et al,4the AL team acquires ability through reflection activities such as communication, discussion,and discovery in the“practice-reflection-practice”cycle,enabling team members to develop a clear self-awareness and take effective action.

2.2.2.Cooperativeness

Some researchers believe that AL is implemented through continuous reflection and learning with the support and cooperation of colleagues and group partners.5In this process,groupmembers jointly analyze problems and cooperate with each other, learning through action practice.It is impossible to perform AL without the support of group partners.Therefore,cooperativeness is the second characteristic of this learning approach.

2.2.3.Subjectivity

Li6suggested that each member of the AL group,as the subject of practice and learning,is the presenter as well as the supporter, observer,questioner,and facilitator of the group.The action of group members is completed through the interactive cooperation of presenters,supporters,and facilitators.Duan7also believed that during the implementation of AL,teachers primarily play the role of“facilitator”.These facilitators provide no advice nordotheyanswer questions;rather,they believe that the answer originates from the participants,and they trigger the potential,wisdom,and creativity of the learners to produce the solution naturally.According to the above points of view,attentively exploring the potential of group members and fully mobilizing their inherent enthusiasm are important factors for the smooth implementation of AL.Because every member participates in the AL group for learning,their subjectivity is the inherent driving force of AL.

3.The application and effect of AL

3.1.AL improves the clinical comprehensive ability of learners

Since AL first emerged,the concept of“reflection in learning, learning in cooperation,and completing specific work target in action”has been rapidly applied to various types of continuing vocational education,higher education,and training programs.8Nursing,a highly practical applied discipline,emphasizes the team cooperation and subjectiveinitiative of nursing staff members in specific practice actions and emphasizes reflection practice, making it suitable for AL.One key element of the educating nurses is that nursing educators must recognize the different learning approaches of their students and maximally stimulate their learning potential.9By considering students as the subjects of teaching,AL improves their comprehensive ability,enhances their cooperation spirit,and triggers their creative thinking while also increasing students'experience and dialectical thinking ability.10,11Therefore,students can enhance their leadership and understanding by providing resources and sharing experiences.12-14Ming et al15applied AL in the training of nursing students and changed the function of teachers from “teach”and“instruct”to“lead”and“guide”,thereby significantly enhancing the autonomous learning motivation of students.Zhang et al16argued that AL can significantly improve students'problem-discovering,problemsolving,self-learning,and critical thinking abilities compared with classroom teaching.AL has been increasingly combined with online learning via the Internet.The Internet,electronic technology,and remote techniques have constantly promoted the development of AL research and facilitated the cross-border,cross-cultural studies of AL.This work offers a diversified viewpoint for researchers to study AL.17For example,Zhang18modified the operating procedure of AL and put forward“micro-AL”by following the concept of“Kolb's Learning Cycle”based on AL.Micro-AL retains the advantage of students combining learning with practice,while partially shortening the learning cycle.In addition,Young et al19applied AL to practice among advanced nurses and found that this approach helped the nursing staff to better show their specialty characteristics;improved the clinical practice effects and comprehensive ability of nursing students;and increased the inpatient satisfaction with regard to nursing students.Moreover,Zhou et al20reported that when nursing students were divided into groups for cooperation and exercise in the contextual model,flexible questioning by teachers improved the communication skills of nursing students with patients.Furthermore,AL enables nursing students to listen and learn from patients as well as reflect on issues regarding patient safety.AL also enhances nursing students'communication abilities.21,22Plack et al23reported the effects of an AL application on pediatric nursing students and showed that this learning approach facilitated students to spontaneously retrieve relevant information and actively participate in a team discussion during or after class,thereby exercising their learning ability and simultaneously improving the effects of learning.Overall,AL has achieved better application effects than other learning approaches.For example,AL improves the communication skills of nursing students in practice,enhances their self-awareness,and strengthens their critical thinking,24thereby helping them to solve problems in practice.Lan et al25indicated that AL is a tool to promote the mutual development of individuals and organizations,thereby contributing to the construction of the learning nursing team. Based on democracy,equality,and mutual support,team members share ideas,contribute experiences,and inspire each other;they work together to solve problems and create a strong atmosphere of learning in the nursing team,laying a foundation for building the learning nursing team.Shen et al26applied AL to the emergency room management quality training of nurses to provide an effective solution to efficient communication in this field.Li et al4argued that AL can accelerate the development of communities as well as enhance repeated communication and cooperation between departments.This approach is conducive to enhance the action execution of organizers and improve the micro-relationship between members and managers.Lamont et al27applied AL to the process of mental health nursing,which effectively improved nurses'reflection and exploration abilities.

3.2.AL promotes educators to reflect the teaching practice

Xiang et al28proposed that AL trains teachers with the educational philosophy of“Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”by teaching students to solve problems in the real world.Li and Zhang et al29,30put forward the idea that the use of AL has certain requirements for teachers and institutional trainers.Specifically,teachers must play an active role in guiding students through the process of AL; teachers must be able to recognize the individual problems encountered by students during the learning process,have sufficient awareness of innovation,and gain the ability to implement teaching by integrating various specific teaching approaches.This strategy also facilitates nursing educators to constantly think and grow and develop more targeted,effective teaching programs.31Haydock et al32indicated that AL can improve the teaching ability of interns and teachers with practical experience.On the whole, AL plays a major role in promoting teachers to reflect on their educational practice.

4.Existing problems in the application of AL

Despite the effective application of AL in practice,the existing research on this learning approach is mostly in the exploration and trial stages.Ma et al indicated that the effect of AL must be assessed through long-term observations,and continuous development and improvement are expected.33

4.1.The ability of nursing educators must be improved

AL requires that educators maximally stimulate students' learning potential and apply a range of teaching and learning methods as well as an assessment system to promote thedevelopment of all learning approaches.Therefore,AL places a higher requirement on educators'abilities.Wang34indicated that teachers should be able to control the direction,progress,and atmosphere of the learning and discussion in the whole group during teaching;they must connect all of the members in the learning group and promote the mutual enhancement of the team and individuals.However,educators are required to further innovate how to efficiently make full use of student initiative for reflective learning;how to realize meticulous design and preparation before class;and how to play the teacher's role as facilitator and collaborator.Moreover,teachers should ask questions in teaching that are based on the existing knowledge and experience of students and can be solved through teacher guidance or group cooperation and investigation.35Therefore,teachers must constantly improve their own coordination abilities and motivation skills in team activities to achieve long-term improvement in the effectiveness of team cooperation.36

4.2.The theoretical model of AL must be constructed

Chen5argued that two theoretical cornerstones currently exist for AL.First,the“experience learning circle theory”proposed bythe American psychologist Kolb argues that experience learning is a cycle that involves four links:concrete experience,reflective observation,abstract conceptualization,and active practice.Second,the constructivist learning theory considers that learning requires intentional,active,conscious,and construction practices; furthermore,sustained behavior change originates more from rediscovering and reconstructing past experiences.In his book“Active Learning in Practice”,Mike Pedler argued that AL is an approach of individual development in an organization,wherein a task is the medium or carrier of learning.Three major factors exist in AL:participants,problems,and the sharing group or team.The individuals make progress through mutual support and challenge or question.AL creates a win-win for personal and organizational development.Problem-based action can solve the problem while changing the problem solver.6This view has promoted the theoretical development of AL.Wu37studied the grounded theory of AL activity based on the practice in local Chinese companies to construct“the continuum model of AL”that comprises one target, two processes,three levels,four stages,and 13 factors.The above studies demonstrate that researchers have made achievements in constructing AL theory in general fields.Although nurses are currently focused on the application and effect of this approach, this theoretical construction must continue to be developed in this discipline.

4.3.The development of an AL assessment system is needed

urgently

The application effect of a learning approach as well as the learning process and training effect must be assessed comprehensively.Participants of the“Active Learning:Assessment Value”international conference held in the United Kingdom in 2010 suggested that the present assessment methods of AL are outdated and that researchers must find additional scientific approaches. Professor Revans,the Father of AL,also stated,“If the research of AL is regarded as fertile soil being developed,the assessment of AL is still to be developed”.17Such an assessment is not only a selfsummary of the learning group but also an objective assessment from the outside in terms of the learning process and trainingeffect in each learning group.35A key issue in current AL research is how to assess the trend of progressive change in students'learning initiative,team cooperation,creative thinking,and problemsolving abilities.It is necessary to explore and build a relatively comprehensive assessment indicator system.

5.Conclusions

AL can improve the comprehensive ability of nursing students while strengthening the teaching reflection abilities of educators. We believe that modern nursing requires that nurses possess certain reflection and cooperation abilities;they must be capable of constant communication and cooperation by combining the problems encountered in clinical practice and able to fully explore the potential of individual subjects;and they must gain sustained development in the action of discovering and solving clinical problems.Therefore,AL is worthy of additional promotion in nursing practice.However,AL also has limitations,given the current immature theoretical model and assessment system.We expect to work with nurses and continue to advance in the process of modifying the theory and assessment system of AL.

Conflicts of interest

All contributing authors declare no conflicts of interest.

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How to cite this article:Han E-H,Zhang Y,Zhang J-G,et al. Advances in the application of action learning in nursing practice.Chin Nurs Res.2016;3:101-104.http://dx.doi.org/10.1016/ j.cnre.2016.06.010

☆This project was supported by 2014 Higher Education Reform Project of Education Department of Henan,China(No.2014SJGLX119).

*Corresponding author.

E-mail address:zhangyanmy@126.com(Y.Zhang).

Peer review under responsibility of Shanxi Medical Periodical Press.

http://dx.doi.org/10.1016/j.cnre.2016.06.010

2095-7718/©2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons. org/licenses/by-nc-nd/4.0/).