Facilitation as a teaching strategy : experiences of facilitators

Tel: (051)401-2407 Fax: (051)9463 E-mail: gnvkem.md@mail.uovs.ac.za Changes in nursing education involve the move from traditional teaching approaches that are teacher-centred to facilitation, a student centred approach. The studentcentred approach is based on a philosophy of teaching and learning that puts the learner on centre-stage. The aim of this study was to identify the challenges of facilitators of learning using facilitation as a teaching method and recommend strategies for their (facilitators) development and support. A qualitative, explorative and contextual design was used. Four (4) universities in South Africa which utilize facilitation as a teaching/ learning process were identified and the facilitators were selected to be the sample of the study. The main question posed during in-depth group interviews was: How do you experience facilitation as a teaching/learning method?. Facilitators indicated different experiences and emotions when they first had to facilitate learning. All of them indicated that it was difficult to facilitate at the beginning as they were trained to lecture and that no format for facilitation was available. They experienced frustrations and anxieties as a result. The lack of knowledge of facilitation instilled fear in them. However they indicated that facilitation had many benefits for them and for the students. Amongst the ones mentioned were personal and professional growth. Challenges mentioned were the fear that they waste time and that they do not cover the content. It is therefore important that facilitation be included in the training of nurse educators.


Introduction
Higher education in general is presently under both internal and external pressure to change and this transformation has put nursing education in the spotlight to change.Evidence of this change is the transfer of hospital-based to communitybased education and the introduction of n o n -tra d itio n a l m ethods such as p ro b lem -b ased learn in g (PB L ), community-based education (CBE) as well as inquiry-based learning (IBL).These methods emphasize that effective learning cannot be limited to the delivery o f in fo rm atio n but that the active participation of the learner is essential (Dolmas, Gijselaers, De Grave, Wolfhagen & Van der Vleuten, 2002: 173).The transformation served as major stimulus for change in the education o f health professionals including nurses ( Mtshali, 2005:5).
Changes in nursing education have a direct influence on nurse educators as they have to keep abreast of the changes occurring in their profession.Their role as teachers, governed by behaviourist ideology w hich is still dom inant in educational programs in South Africa, are put under the spotlight to change to a student-centred approach.Central to this c h allen g e is the d esire to achieve m ean in g fu l, lifelo n g learn in g and p erso n al grow th.The focus on transformation in nursing education is the development of a student nurse to be a critical thinker and a self-directed learner.
The starting point would be the revision of the traditional teaching role of the lecturer of im parting know ledge to facilitating the learning (Dolmas et al, 2002: 173).Effective learning is possible when the role of the teacher is not that of a controller and deliverer of pre-packed knowledge and the dictator of what the student should learn to facilitation which demands a shift from teacher to studentcentred instruction (Kwan, 2004:1186, Johnston & Tinning, 2001:161).Changing the teach in g ro le to fa c ilita tio n n ec essita tes th at g u id e lin e s for facilitation should be developed because in the past lecturers were trained to lecture and not to facilitate learning.

Research problem
Problem-based learning methodologies are now extensively utilized within co n tem p o rary nu rsing cu rricu lu m (Johnston & Tinning, 2001:161, Haith-Cooper, 2003:65).The School of Nursing of the Free State University introduced problem -based learning (PB L) in 1997.With the introduction of PBL, the planning of the curriculum was extensive, the focus was on the process of PBL and not much on facilitation.All lectures were trained to lecture and not to facilitate learning.Lecturers aired their concerns: they felt insecure in facilitating learning.Their main concern was that they had not received adequate preparation for their new role and that they found it difficult to adapt to this mode of teaching.
Most lecturers at that time had primarily lecturer-based experience and had no role m odels they could em ulate to facilitate learning.Moving out of the traditional didactic style of teaching to facilitation of learning was difficult for many.Most facilitation was learned by trial and error and there was no role model or expert who could demonstrate good facilitation.This was confirm ed by research conducted by Fichardt & du Rand (2000: 3) on asse ssin g the perceptions of facilitators of PBL and CBE in the school of Nursing of the Free State University.Based on these statements there was a need to ad d ress the challenges that facilitators were facing regarding their new role of facilitation and recommend measures to assist them to adapt to this mode of teaching.

Aim of the study
The aim of this study was to identify the challenges of facilitators of learning using facilitation as a teaching method and recom m end strateg ie s for th eir development and support.Objectives of the study are to: • determine the needs of facilitators • identify problems of facilitators • recommend the strategies for developing and supporting facilitators to assist them in adapting to the process of facilitation.

Research design
A qualitative explorative descriptive and contextual approach was used to identify the challenges of facilitation faced by facilitators of learning in a problem-based setting.One main question posed during in-depth group interviews was: How do you experience facilitation as a teaching/ learning method?.

Population and sampling
The p o p u latio n o f this stu d y w as purposively selected which is common in qualitative research ( Polit, Beck & Hunlger, 2001:246).The sample of this study included the facilitators in the schools and departments of nursing of four (4) South African universities using facilitation as a teaching-learning method.

Data collection and analysis
Data was collected by conducting focus group interviews.In total four (4) focus group interviews were conducted with facilitators, one in each university with members ranging between 6-10 members w hose opinions and experiences o f facilitation were solicited simultaneously (Polit, et al, 2001:268).Each group consisted of facilitators of first up to the fourth year of study.The purpose of the interviews for this study was to obtain in-depth information from a few cases.This is characteristic o f q u alitativ e research (Moloto, 1999:38).Data was collected until saturation was reached.Chakalane-Mpeli (2004:27) and Streubert Speziale and Carpenter, (2003:33) state that saturation of data is the determinant of sample size which occurs when there is em ergence o f re p eatin g them es.
In terv iew s w ere co n d u cted by the moderator.According to Moloto (1999:57) the researcher and moderator in focus groups are one and the same.In this re searc h the re s e a rc h e r and the moderator were two different people and had different roles.The researcher was an observer taking field notes whereas the moderator was the facilitator of focus group in te rv ie w s, c o n tro llin g the dynamics within the groups, such as dominating individuals and help prevent group conformity (Babbie, 2004:305).The m oderator was a p sy ch iatric nurse specialist skilled and experienced in focus group management.She is also an expert in qualitative research and was familiar with the research .Field notes were taken to record observations, capture actual d iscu ssio n s, co m m u n icatio n s and perceptions since memory cannot be trusted (Babbie,2004:305).Taking foot notes assisted in transcribing and was the first step of data analysis.(L in co ln & G uba, 1985:290-327).Credibility was achieved by cross-examination of data which was done by reading the transcripts in their entirety several time, immersing in the details getting the sense of the interviews before categorizing the data (De Vos, Strydom, Fouche, & Delport 2003,343) and , re-coding the existing data where necessary .Dependability was ensured by dense description of data and the use of the co-coder.T ransferability was ensured by selecting the sample and a context from which much can be learned about facilitation which is a phenomenon of interest hence purposive sampling was used.Being close to respondents when conducting fo cu s group interview s ensured conformability.Focus groups should be seen as a way of closing the gaps betw een people as interactions fosters understanding of each other from people sharing personal and sim ilar experiences (de Vos, et al 2003,307).Small groups of between 5-10 members as in focus groups interview s (Polit et al, 2001:265) are conducive to less physical distance and fosters closeness.

Data Analysis and Discussions
D ata w as an a ly z ed by m eans o f a combination of Tesch (1990) in Cresswell (1994:153-155) who described eight steps of analyzing data and the basic steps of G iorgi (1970) as quoted by Om ery (1983:49-63).D ata was categorized according to repeated tendencies.After completing to analyze the data, the final copy of the product was submitted to the to co-coder for critiq u e and/or acceptance.
Description of the facilitation process (Figure1.1)Facilitators described the facilitation process in different ways as shown in Figure 1.1.
Facilitators described facilitation (see figure 1.1) as a challenge to them as expressed in the following quotation "I think facilitation is a challenge but I mean challenging in another way and in another sense.In the old traditional m ethod you had this co m fo rt zone around you.You were not required to be involved to the extent that you are involved now.You have to be more wide awake definitely".According to this quotation the focus of the challenge is the changing roles and the difference betw een facilitatio n and traditional lecture methods.The reason for this challenge is that lectures in contrast to facilitations consist of didactic exercises and the lectures have a lecture-based experience and it is understandable that they can feel uncomfortable with the role of facilitation (Dolmas et al, 2004:173).
F a c ilita to rs also m en tio n ed th at facilitation demands that they change their way of thinking and behaving in order to facilitate.In support to what is stated by facilitators, Johnston and Tinning (2001:101) says that facilitation demands a shift from a teacher to a student-centred instruction.Facilitation was also described by facilitators as a different way of teaching.Brobanck and MacGill (1998:145) in support to the view s o f the fa c ilita to rs, d escrib e fa cilitatio n as ju s t an o th er way of teaching.All four groups of facilitators mentioned that it was difficult for them to facilitate in the beginning because as teachers they wanted to teach and talk.As one facilitator said, "I can say if you are a real lecturer in the traditional sense then it is difficult to back o ff".Another source of difficulty as indicated by facilitators was the lack of structure on how to facilitate.The facilitators felt as though they did not have these guide lines which traditional teaching offers.O ther re searc h ers had th e sam e perception of facilitation process in their studies.Fichardt and du Rand (2000:3-10), Biley and Smith (1999:1205-1212) in their studies, state th at facilitato rs pointed out that there was insufficient structure provided and that they were worried whether the students obtained adequate information.The literature also documents that it is difficult to give meaningful 'hands on ' facilitation (Haith-C ooper, 2003: 598).H ow ever, all facilitators stated that they grasped the process of facilitation in the course of     Facilitators also depended on support groups from other facilitators who had knowledge of facilitation.In addition to support, group co-facilitation which is a strategy whereby colleagues sit in and take part in tutorials and comment on fa c ilita tio n was used .T his gives facilitators an opportunity to facilitate th eir peers and p ro v id es a safe environment for facilitators.In this process of co-facilitation facilitators work together, and model with each other within a teaching session.Johnston and  Haith-Cooper, 2003:65, Steinert, 2004:286, Johnston and Tinnings, 2001: 161).It was therefore important that facilitators are prepared and developed to facilitate learning.
Challenges of the facilitation process (Figure 1.6) C hallenges for this study are those factors in facilitation viewed as having a negative impact on facilitators.These will be discussed as indicated in Figure 1.6.
Facilitators were uncertain of whether the students would be able to cover the content and com plete their learning outcomes.Steinert and Snell (1999:37-42) indicate that the fear of not covering content is a common phenomenon in interactive lectures and this is because facilitators think that they will sacrifice important content when students are more involved.Time constraints was mentioned as a challenge by facilitators.Some fa c ilita to rs in d icated that preparation for class was a challenge as it was time-consuming and that they needed to come to class well prepared.
The following excerpt exemplifies such a concern "The difficulty we found was when do we fit the time fram e because it took a long time.It took the whole morning to go through that problem and to come with the learning goals at the end o f that session".The time factor is not related to facilitation per se but to the PBL approach which according to 66 Curationis August 2006 Lehtinen (2002:109) because o f its structure, is organized according to a sequence of distinguishable steps which consumes a lot of time to complete.Lack o f stru ctu re w as an o th er co n cern h ig h lig h ted by fa c ilita to rs, som e researchers also lam ented that that facilitators as well as students perceived facilitated learning programmes lacked some structure and learning guidance ( W illiam s, M acD erm id and W essel 2003and W essel :206, Treloar et al, 2000:708):708).

Benefits of facilitation (figure 1.5)
F ac ilita tio n also had rew ard in g challenges for facilitators and students as reflected in figure 1.5 Facilitators indicated that the process of facilitation developed them personally and professionally.Thomas (2004: 136) maintain that facilitation is a body of know ledge and skills w hich should empower people.Studies indicate that the rewards of facilitation are numerous because they evoke a radical change in students and teac h ers alik e, both personally and professionally (Cassimjee  & B rookes,1998:96).Facilitators also ex pressed th at stu d ents w ere m ore responsible and they take decisions for th eir learn in g .An exam ple o f this resp o n sib ility is noted in the study conducted by Williams et al (2003:200) where facilitated students come with strategies to structure their learning, p rep are fo r re so u rc e sessio n s and organize their notes.Students are said to be able to reso lv e co n flict.Taylor (1997:67) states that students learn a great deal in groups about how to make decisions and handle conflict.
A n o th er b e n e fit id e n tifie d is that students are more competent in their skills.Katz (1995:70) describes them as confident nurses both in the classroom and the clinical setting who question, challenge and refuse to be intimidated or silenced.Facilitators also mentioned that they gained group management skills and that they learned from students.Crew (1999:19-20) states that facilitators should look for knowledge useful to them from learners contribution and must act on the belief that they can learn from learners.F acilitators also indicated that they enjoyed facilitation.Other researches has also cited instances where facilitators enjoyed facilitation (Solomon & Crowe, 2001:185).The following statements bear testimony to this statement: "I fe e l facilitation is more enjoyable than the lecture method because when you facilitate you are moving together with the students".
"There is lots more to learn on how to manage this.I wouldn't go back fo r anything, because o f the richness o f teaching and learning".
Facilitators also mention that they had a special relationship of caring and trust w ith th eir stu d en ts.F in a lly som e facilitators indicated that they learned about d ifferen t cultures from their students.Junn (1994:130) asserts that each student brings into the classroom a wealth of unique or personal cultural knowledge that can be tapped as a rich learning resource.

Conclusion
The study was undertaken to determine the ch a lle n g es th at fa c ilita to rs experienced in a problem-based setting within the context of nursing education.The data indicates that facilitation is a challenge for facilitators and it requires a total m ind set change.F acilita to rs experience negative em otions in the beginning and fear loss o f control.Adequate preparation for the role of facilitator and orientation seem to be very important to them.The research showed that although facilitators experienced difficulty in facilitating, some described it as a challenge with added advantages.S trateg ies th at m ay assist in the preparation of facilitators in their role were recommended.

Recommendations
The recommendations for preparation of 67

Curationis August 2006
facilitators include orientation, education and support.

Orientation
All facilitators should be provided with orientation sessions.The orientation of facilitators should be designed with strategies that mirror the processes that students will undergo.In other words orientation sessions should be presented to resemble a typical learning package like the one students experience TrustworthinessQ ualitative researchers use different criteria of trustworthiness when defining reliability and validity.They use terms 62 Curationis August 2006 such as consistency, dependability, co n fo rm ab ility , c re d ib ility and transferability (Leiniger 1991 in Brink 19%: 124).T rustw orthiness was m aintained by using s tra te g ie s o f c re d ib ility , tra n sfe ra b ility , d ep e n d a b ility and co n fo rm a b ility

FIGURE
FIGURE 1.1: Description of facilitation

FIGURE
FIGURE 1.4: reflected in figure 1.4 indicated that they had no formal preparation of facilitation and others stated that they had to facilitate by trial an error.Most facilitators stated that workshops were conducted and these are commonly used in attempt to prepare them for their new role (M audsley, 2003:418).0thermethods of preparation 65 Curationis August 2006 include an educational course with facilitation as a theoretical background, reading about fa c ilita tio n , d em o n stratio n s, fa c ilita tio n un d er sup erv isio n .The use o f ex p ert facilitators, making use of students' feedback as a means of improving their facilitation strategy.Studies has proven that stu d e n ts' fe ed b ac k can be o f assistance in assisting educators to change their methods of teaching (Pinto, R endas and G am boa (20 0 1 :2 9 2 ).

FIGURE
FIGURE 1.6: O LO TO , JC 1999: A model for the reintegration of marginalized adolescents into the com m unity to facilitate the restoration, promotion and maintenance of their mental health.Johannesburg: Rand A frikaans University (doctoral degree).A M A Z O , B 2005: C hallen g in g tra d itio n a l teac h in g and L earning paradigm s: O nline learn in g and em an cip ato ry teach in g .N ursing Education Perspectives.26 (6):340-343.
B R A N D , G 20 0 3: Im agining a H A IT H -C O O P E R , M 2003: An exploration of tu to r's experience of 68 Curationis August 2006 facilitating problem-based learning.Part 2-Im plications for the facilitation of problem-based learning.Nurse education today, 23 (l):65-75.M cLEAN, M 2003: What can we learn from facilitators and student perceptions of facilitation skills and roles in the firs y ear o f a p ro b lem -b a sed learn in g curriculum?.BMC Medical Education.3 (9).M S T R E U B E R T S P E Z IA L E , H J & C A R PEN TER, DR 2003: Qualitative research in nursing.A dvancing the h u m an istic im p era tiv e. 3 rd ed.Philadelphia.Lippincott: W illiams & Wilkins.SHO VEIN, J ; HUSTON, C; FOX, S & D