Nurses’ perceptions and parents’ experiences of learning principles used within health education practice - an action research study
Main Article Content
Abstract
Background: Patient/parent/family education (PPFE) commonly involves children’s nurses. They help parents to learn ─ interactively encode information, link new and existing knowledge, construct meaning and transform information to usable knowledge, building the skills to manage their children’s health/wellbeing. Ways nurses facilitate learning using Learning Principles (subjective/invisible practice aspects promoting deep thinking/metacognition) and which ones are important to parents’ learning are un-explained in nursing. Three action research cycles explored and mapped nurses’ use of Learning Principles within PPFE. This paper reports Cycles two and three ─ cycle one is published elsewhere.
Method: In Cycle two, Stringer’s Look, Think, Act approach within focus groups, involved nurses (n= 23) and parents (n= 8) from one Australian health network. Participants explored their perceptions and practice through interactive discussions and feedback ─ Look(ed). Look shifted to Think, as participants sorted their ideas, tested them against those of others, posed new questions, uncovered using and experiencing Learning Principles. Act involved stimulating nurses to draw up their tacit knowledge.
In a collaborative workshop (Cycle three), participants brainstormed, used creative, critical thinking and a decision-making matrix to determine the content and format to communicate those key Learning Principles used/experienced in PPFE to others.
Results: Cycle two’s thematic analysis coded Learning Principles nurses used/parents experienced to five themes. Shifting from ‘automatic’ behaviours and knowing ‘what would work’, nurses made sense of theory/practice connections and ways they used Learning Principles important to parents’ needs. Mapped Learning Principles aligned with the Dimensions of Learning framework from educational-psychology, a framework rarely integrated into nursing’s PPFE.
In Cycle three’s data synthesis, participants and the researcher identified ways to integrate the Learning Principles into a parent-education resource using the Dimensions of Learning framework. Cues guide nurses in ways cognitive and adult Learning Principles promote learners’ thinking (metacognition) in PPFE.
Conclusion: Mapping, describing and creating of a resource now shows how nurses use and parents experience Learning Principles in PPFE. Further research can determine the resource’s value in communicating the role of Learning Principles in the learning process ─ importantly, the information transformation process to usable, meaningful knowledge vital for self-management.
Article Details
How to Cite
THOMPSON, Dr Deryn et al.
Nurses’ perceptions and parents’ experiences of learning principles used within health education practice - an action research study.
Medical Research Archives, [S.l.], v. 14, n. 1, feb. 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7251>. Date accessed: 03 feb. 2026.
doi: https://doi.org/10.18103/mra.v14i1.7251.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. World Health Organisation. Therapeutic Patient Education: an introductory guide, Copenhagen: WHO Regional Office for Europe; (2023). Accessed November 1, 2025.
3. Grant J, Mitchell C, Cuthbertson, L. National Standards of Practice for Maternal, Child and Family Health Nursing Practice in Australia, Adelaide, Australia: Flinders Press; 2017.
4. Wolf M, Wilson E, Rapp D. et al. Literacy and learning in health care. Pediatrics. 2009; 24(3), suppl. 3:275–81. doi:10.1542/peds.2009-1162C
5. Thompson D, Leach M, Smith C, Fereday J, May E. How nurses and other health professionals use learning principles in parent education practice: a scoping review of the literature, Heliyon;6(3):1–24. doi: 10.1016/j.heliyon.2020.e03564
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7. Eberly Centre. Learning Principles. Carnegie Mellon University, Pittsburgh.
https://www.cmu.edu/teaching/principles/learnin.html. Published 2019. Accessed 16 October, 2025.
8. Brown A. The Advancement of Learning, Educ Res.1994;23(8):4-12.
9. Gagné R, Wager W, Golas K, Keller J. Principles of instructional design. 5th ed. Thomson Wadsworth Belmont, California; 2005.
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11. Griffith B, Loveless D. eds. The interdependence of teaching and learning, Information Age Publishing, Charlotte, North Carolina; 2013.
12. Knowles MF, Holton E, Swanson R. The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. 8th ed. Oxon: Routledge, Taylor & Francis. Francis, Oxon; 2015.
13. Anderson J. Cognitive psychology and its implications. 6th ed, Worth Publishers, New York; 2005.
14. Thompson D, May E, Leach M, Smith C, Fereday J.The invisible nature of learning: patient education in nursing, Collegian. 2021; 28(3):341-345.
15. Kivunja C, Kuyini A. Understanding and applying research paradigms in educational contexts. Int J High Educ. 2017; 6(5):26-41.
doi: 10.5430/ijhe.v6n5p26
16. Ormston R, Spencer L, Barnard, M, Snape D. Foundations of Qualitative Research. In Ritchie J, Lewis J, McNaughton Nichols C, Ormiston R. eds. Qualitative Research Practice, 2nd ed. Sage Publication, Ltd. London;243-65.
17. Stringer E. Action Research. SAGE Publications Inc., Thousand Oaks, CA; 2007.
18. Thompson D, May E, Leach M, Smith C, Fereday J. Applying Learning Principles Within Parent Education: Exploring Nurse' Practice and Parents' Experiences. Patient Prefer Adherence. 2023; 17: 2949-2970, doi: 10.2147/PPA.S426043Â. https://pubmed.ncbi.nlm.nih.gov/38027081
19. Benner P. Taking a stand on experiential learning and good practice. Am J Crit Care. 2001;10(1):60-62. doi: 10.4037/ajcc2001.10.1.60
20. Gustavsen B. Theory and practice: the mediating discourse. In Reason P, Bradbury H, (eds), The handbook of Action Research, SAGE Publications Ltd, London. 2006;17-26
21. Hegney D, Francis K. Action research: changing nursing practice. Nurs Stand. 2015; 29(40): 36–41.
22. D’Eredita M, Barreto C. How does tacit knowledge proliferate? An episode-based perspective, Organ Stud. 2006; 27(12):1821–41. doi: 10.1177/0170840606067666
23. Navon E. The third debate revisited. Rev Int Stud. 2000; 27(4):611–25.
doi:10.1017/S0260210501006118
24. Thomas A, Menon A, Boruff J, Rodriguez A, Ahmed S. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. Implement Sci. 2014; 9(1):54–74.
doi: 10.1186/1748-5908-9-54
25. Given, L. Constructivism. In Given L. ed. The Sage encyclopedia of qualitative research methods, SAGE Publications Inc., Thousand Oaks, 2008; 116–120.
26. Gaventa J, Cornwall A. Challenging the boundaries of the possible: participation, knowledge and power, IDS Bull. 2006; 37(6):122–28. doi: 0.1111/j.1759-5436.2006.tb00329.x
27. Holter I, Schwartz-Barcott D. Action Research: what is it? How has it been used and how can it be used in nursing? J Adv Nurs. 1993; 18(2):298–304. https://doi.org/10.1046/j.1365-2648.1993.18020298.x
28. Leitch R, Day C. Action Research and reflective practice: towards a holistic view. Educ Action Res. 2000; 8(1):179–93. doi: 10.1080/09650790000200108
29. National Health and Medical Research Council (NHMRC). Australian Code for the Responsible Conduct of Research, Australian Research Council and Universities Australia.
https://www.arc.gov.au/about-arc/program-policies/research-integrity/australian-code-responsible-conduct-research-2018
30. Polit, D, Beck C. Nursing research generating and assessing evidence for nursing practice. 10th ed. Wolters Kluwer, Philadelphia. 2017.
31. Liamputtong, P. Focus group methodology: principles and practice. SAGE Publications Ltd, London; 2017.
32. Lambert S, Loiselle C. Combining individual interviews and focus groups to enhance data richness. J Adv Nurs. 2008; s62(2):228–37. doi: 10.1111/j.1365-2648.2007.04559.x
33. Orngreen R, Levinsen K. Workshops as a research methodology, J Educ Elearn. 2017: 15 (1):70.
34. Braun V, Clarke V. Successful Qualitative Research: A Practical Guide for Beginners. London, England: SAGE Publications; 2013.
35. Marzano R, Pickering, D, Arredondo, D, et al. Dimensions of Learning Teacher's Manual , 2nd ed, Mid-Continent Regional Educational laboratory, Colorado;1997.
36. Baillie L. Promoting and evaluating scientific rigour in qualitative research. Nurs Stand. 2015;29 (46):36-42. https://doi.org/10.7748/ns.29.46.36.e8830.
37. Scott H, Fawkner S, Oliver C, Murray A. Why healthcare professionals should know a little about infographics. Br J Sports Med. 2016; 50(18);1104–1105
38. Bradshaw MJ, Porter S. Infographics: A New Tool for the Nursing Classroom. Nurse Educ. 2017; 42:57–59.
39. Arcia A, Suero-Tejeda N, Bales M et al. Sometimes more is more: iterative participatory design of infographics for engagement of community members with varying levels of health literacy. J Am Med Inform Assoc. 2015; 23(1):174–183.
40. Shoghi M, Sajadi M, Oskuie F, Dehnad A, Borimnejad L. Strategies for bridging the theory-practice gap from the perspective of nursing experts. Heliyon. 2019; 5(9):e02503. 10.1016/j.heliyon.2019.e02503
41. Aronson E, Bridgeman D. Jigsaw groups and the desegregated classroom: In pursuit of communal goals. J Pers Soc Psychol. 1979;37(7):1309-1319. https://doi.org/10.1177/01461672790050040
42. Aronson E. The Jigsaw Classroom. Social Psychology Network. http://www.jigsaw.org. Published 2000. Accessed December 23, 2025
43. QSR International, NVivo 12, viewed 2 March 2018, https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
44. American Society of Quality [ASQ]. What is a matrix diagram? 2018; Accessed November 3, 2025. https://asq.org/quality-resources/matrix-diagram
45. Öberg J, Hernwall P. Participatory design with teachers: designing the workshops, in Designs for Learning. Proceedings of the 5th International Conference on Designs for Learning, 2016. Copenhagen; 269–282.
46. Bazeley P, Jackson K. Qualitative data analysis with NVivo. SAGE Publications Ltd, London; 2013.
47. Clapper T. Beyond Knowles: What those conducting simulation need to know about adult learning theory. Clin Simul Nurs; 2009; 6(1): pp. e7–e14. doi:10.1016/j.ecns.2009.07.003
48. Merriam S. Adult learning theory: evolution and future directions ', PAACE Journal of Lifelong Learning; 2017;26; 1–37.
49. Kaakinen J, Arwood E. Systematic review of nursing simulation literature for use of learning theory. Int J Nurs Educ Scholarsh, 2009. 6(16). https://doi.org/10.2202/1548-923X.1688
50. Kothari A, Rudman D, Dobbins M, et al. The use of tacit and explicit knowledge in public health: a qualitative study. Implement Sci. 2012; 7(1):20–32. doi: 10.1186/1748-5908-7-20
51. Kuiper R, Pesut D. 2004. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self‐regulated learning theory. J Adv Nurs. 2004;45(4);381–91
52. Kosior K, Wall T, Ferrero S. The role of metacognition in teaching clinical reasoning: theory to practice. Educ Health Prof. 2019;2:108–14, doi: 10.4103/EHP.EHP_14_19
53. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice-Hall; 1986.
54. Bandura A. Self-Efficacy: The Exercise of Control. W.H. Freeman; 1997.
55. Rogers C. Freedom to learn for the 80s. Charles E. Merrill Publishing Company, Columbus, Ohio; 1983.
56. Maslow A. Motivation and Personality, Harper and Row, New York. 1970.
57. Bjork, R, Dunlosky, J & Kornell, N. 2013, Self-Regulated Learning: Beliefs, Techniques, and Illusions, Annu Rev Psychol. 64(1);417–444.
58. Culyer L, Jatulis L, Cannistraci P, Brownell C. 2018. Evidenced-based teaching strategies that facilitate transfer of knowledge between theory and practice: what are nursing faculty using? Teach Learn Nurs. 2018; 13(3):174–79. https://doi.org/10.1016/j.teln.2018.03.003
59. ten Cate O, Snell L, Mann K, Vermunt J. Orienting teaching toward the learning & process; Acad Med. 2004; 79(3):219–28.
60. Tanner K. Promoting student metacognition. CBE Life Sci Educ. 2012. 11(2):113–20.
https://doi.org/10.1187/cbe.12-03-0033
61. Fish D, De Cossart L. Thinking outside the (tick) box: rescuing professionalism and professional judgement’, Med Educ; 2006;40(5);403–404.
62. Rydenfält C, Ek Å, Larsson P. Safety checklist compliance and a false sense of safety: new directions for research. BMJ Qual Saf; 2014; 23(3):183–186.
63. Nightingale R, Wirz L, Cook W, Swallow V. Collaborating with parents of children with chronic conditions and professionals to design, develop and pre-pilot PLAnT (the Parent Learning Needs and Preferences Assessment Tool)', J Pediatr Nurs, 2017; 35; 90–97, doi: 10.1016/j.pec.2015.05.002
64. Svavarsdottir H, Sigueoardottir A, Steinsbekk A. How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education. BioMed Central; 2015; 15(1), 1-9.
65. Vries-ErichJ, Reuchlin K, de Maaijer P, van de Ridder M. Identifying facilitators and barriers for implementation of interprofessional education: Perspectives from medical educators in the Netherlands, J Interprof Care, 2017; 31:2; 170-174, doi: 10.1080/13561820.2016.1261099
66. Peddle M, Bearman M, Radomski N, Mckenna L, Nestel D. ‘What non-technical skills competencies are addressed by Australian standards documents for health professionals who work in secondary and tertiary clinical settings? A qualitative comparative analysis’, BMJ Open; 2018; 8(8); e020799–e020799.
67. Hoffman K, Aitkin L, Duffield C. (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis. Int J Stud Nurs; 2009; 46(10): 1335-44. doi: 10.1016/j.ijnurstu.2009.04.001
68. Ingvarsson E, Verho J, Rosengren K. Managing Uncertainty in Nursing - Newly Graduated Nurses' Experiences of Introduction to the Nursing Profession. Int Arch Nurs Health Care: 2019; 5:119. doi.org/10.23937/2469-5823/1510119.
69. ANSAT. ANSAT Resource Manual for RNs. ANSAT; 2018. Accessed December 23, 2025. https://www.ansat.com.au/home/resources
70. Trento M. 2019. The utopia of research: epistemology of patient education, Acta Diabetol. 2019; 56(2);145–150.
71. Suter P, Suter W. Patient education. Timeless principles of learning: a solid foundation for enhancing chronic disease self-management, Home Healthc Nurse. 2010; 6(2):82–8.
10.1097/01.NHH.0000311024.11023.09
72. Thompson D, Thompson M. Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice', J Adv Nurs.70(11); 2483–2494. doi:10.1111/jan.1243.