NURS 767 Week 2 Written Assignment 2 Example

Learning Theory for Teaching Postpartum Hemorrhage: Benner, Cognitive Load and Kolb's Cycle Across Classroom, Lab and Clinical

The Teaching Problem

Severe bleeding after birth remains among the most common causes of maternal death and is one of the emergencies a maternal-newborn nurse must recognize quickly. It is also rare enough that most junior students will never see one during their clinical days. Students need to learn the normal postpartum assessment, recognize the cues that signal excessive bleeding, act in the first minutes and understand why quantitative measurement of blood loss matters. My practicum gives me three opportunities to teach this content: a flipped class, a simulation in the lab and the clinical days on the postpartum unit. Oermann et al. (2018) urge new educators to plan from an understanding of how students learn rather than from the content outline alone, and this paper applies three theories to that plan.

Benner: Where the Students Start

Benner (1984) described five stages in the development of clinical skill, from novice through advanced beginner, competent and proficient to expert. Novices have no experience of the situations they are expected to handle, so they rely on context-free rules and measurable signs: a fundus that is firm or boggy, a pad saturated in a stated amount of time, a heart rate above a set number. They cannot yet see a situation as a whole. Junior students in a maternal-newborn course are novices in this content, even if they are advanced beginners in adult health.

Chan et al. (2025) draw on Benner's writings to argue that clinical education should aim at practice readiness, focusing on the competencies of nursing practice rather than its tasks. For a novice, that means teaching cues and actions in a way that builds toward judgment, not only checklists.

What it changes: the class and simulation will teach explicit cues and thresholds, such as a boggy fundus, steady trickling, a rising heart rate and falling blood pressure, and the first actions in a fixed order: fundal massage, call for help, increase intravenous fluids and give uterotonic medication as ordered. Students will be told that these are a starting structure, and the clinical days will show them how real patients vary.

Cognitive Load: How Much at Once

Sweller (1988) showed that problem solving places heavy demands on working memory and that novices learn better from studying worked examples than from solving problems with no guidance, because the effort of searching for an answer uses up the working memory a beginner would need to grasp how the problem is built. Cognitive load theory, which grew from this work, holds that instruction should limit unnecessary demands on working memory, particularly for novices.

A postpartum hemorrhage carries a heavy load: anatomy of the uterus, causes summarized as the four Ts (tone, trauma, tissue and thrombin), vital sign changes, medications with their contraindications, blood loss measurement and team communication. Presented all at once, it will overwhelm students who are still learning the normal postpartum assessment.

What it changes: the pre-class video, originally a 40-minute recorded lecture, will be cut to an eight-minute worked example of one patient's hemorrhage from first cue to stabilization, followed by a one-page reference card. Medications will be limited to the first-line uterotonics for the first exposure. Students will see a complete, correct example before they are asked to act in simulation, which is the sequence the worked example effect recommends for novices.

Kolb: Connecting Three Settings Into One Cycle

Kolb (2015) describes learning as a cycle in which a person has an experience, reflects on it, builds concepts from the reflection and then tries those concepts out, which leads to a new experience. The cycle can begin at any point, but leaving a stage out leaves the learning unfinished: an experience never reflected on teaches little, and a concept never tried in practice stays abstract.

My three teaching settings can be arranged as a cycle. The simulation gives the concrete experience that clinical placements rarely provide. Debriefing provides the reflective observation. The flipped class, placed after the first simulation rather than before it, supports abstract conceptualization by connecting what students saw with the physiology and evidence. The second simulation and the clinical days provide active experimentation, in which students apply the concepts to new patients. Evidence supports simulation as the concrete experience for this content. Fernández Idiago et al. (2026) evaluated a high-fidelity obstetric emergency simulation program with 82 third-year nursing students, covering emergencies that included postpartum hemorrhage, and found significant improvements in knowledge of complex obstetric maneuvers and in students' perceived safety in managing emergencies, along with reports of emotional preparedness and the value of reflective debriefing.

What it changes: the order of activities. The original plan put the class first, then simulation, then clinical. The revised plan puts a short first simulation, after the worked-example video, before the class, so students arrive with an experience to make sense of.

The Sequence

Why These Three and Not Others

Other theories could apply. Behaviorist approaches suit drill on skills such as fundal assessment, and the lab will use repeated practice for that, but behaviorism says little about recognizing an emergency as it develops. Constructivist accounts of learning stress that students build knowledge from what they already know, which is part of why the simulation now comes first, but Kolb's cycle gives a more practical structure for sequencing three settings. Adult learning principles, which emphasize relevance and self-direction, fit graduate students better than junior undergraduates who are still learning what is relevant. The three chosen theories each answer a different question in the plan: Benner tells me who the students are, cognitive load theory tells me how much to give them and Kolb tells me in what order.

The theories also fit together. Benner's novices need explicit rules, which a worked example supplies; the worked example keeps cognitive load low, which leaves capacity for the reflection Kolb's cycle requires; and the reflection, in debriefing, is where novices begin to see that the rules have exceptions, the first step toward the advanced beginner stage. Oermann et al. (2018) encourage new educators to build a small set of theories into a coherent approach rather than borrowing a technique from each, and this plan tries to follow that advice.

Debriefing as the Reflective Step

Because reflection is the stage most often rushed, the debriefing questions are written in advance: which cue caught your attention earliest, how you interpreted it, which action you chose and what you would change next time. Each question maps to a part of the cycle and to the cues the class will later explain. Students who struggle to answer the first question will be the ones to watch on the clinical unit.

Limits of the Plan

Theories describe learners in general; my students will differ. Some have worked as nursing assistants on a mother-baby unit and may be advanced beginners already. The debriefings and clinical conversations will show me where each student stands, and I will adjust the cue lists and the second simulation's difficulty accordingly. The clinical setting also limits what I can plan: patients cannot be scheduled, and a student may care for a patient with heavier than normal bleeding without any warning, which will be both a learning opportunity and a test of whether the earlier activities worked.

Conclusion

A theory earns a place in a teaching plan only if it changes what the teacher does on Monday morning. Benner's model sets the level at which to teach, cognitive load theory limits the first exposure and Kolb's cycle reorders the three settings so that experience comes before explanation. Practicum Log 1 will record whether students who met the hemorrhage first in simulation made more sense of the class that followed.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Chan, G. K., Benner, P., Burns, E. M., Orozco, R., Bowman, M., Escobedo-Wu, E. L. G., & Vallejo, E. (2025). Establishing the "north star" for clinical education to accelerate practice readiness: Implications for leaders, faculty, educators, nursing professional development practitioners, and preceptors. Nursing Administration Quarterly, 49(3), 206-225. https://doi.org/10.1097/NAQ.0000000000000684

Fernández Idiago, M., Velarde-García, J. F., Arrogante, O., Zaragoza-García, I., Álvarez-Embarba, B., Fernández-Alonso, V., & López-Pedraza, L. (2026). Preparing nursing students for obstetric emergencies: Effects of high-fidelity simulation on knowledge, confidence and learning. Nursing Reports, 16(4), 137. https://doi.org/10.3390/nursrep16040137

Kolb, D. A. (2015). Experiential learning: Experience as the source of learning and development (2nd ed.). Pearson Education.

Oermann, M. H., De Gagne, J. C., & Phillips, B. C. (Eds.). (2018). Teaching in nursing and role of the educator: The complete guide to best practice in teaching, evaluation, and curriculum development (2nd ed.). Springer Publishing Company.

Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12(2), 257-285. https://doi.org/10.1207/s15516709cog1202_4