Nursing is a practice discipline. As such, theory and practice cannot be separated: theory guides practice, and practice informs theory. Yet nursing education is traditionally divided into two components - classroom or theory-based learning and clinical or practice-based learning - which has contributed to the theory-practice gap, one of the most significant issues in nursing.
Matching textbook descriptions of clinical entities with the complex reality of nursing practice is an ongoing challenge for nurse educators (Scully, 2011). Ajani and Moez (2011) point out that the theory-practice gap is experienced most acutely by nursing students who are faced with real clinical situations in which they are unable to generalize from what they learned in the classroom. With today's emphasis on evidence-based practice, bridging the gap requires the use of learning strategies to help the learner connect prior knowledge (i.e., theory from lectures or readings) to the practice setting (i.e., active learning in the clinical setting). This article describes the use of a K-W-L (know, want to know, and learned) chart as an approach to bridge the theory-practice gap and to encourage students to take ownership of their knowledge and become engaged, self-directed learners.
THE K-W-L CHART
The K-W-L chart provides a framework for summarizing one's current knowledge, identifying learning goals, and thinking about new learning in the context of existing knowledge. From the discipline of education, Ogle (1986) introduced the K-W-L chart to help students actively think about reading an expository text. The chart is a graphic organizer that guides the learner in gathering and applying knowledge or key information, enabling the learner to use prior learning to make a personal connection in a learning experience.
The literature supports that learners construct and process new information and experiences based on prior knowledge (Clapper, 2014; Rotgans & Schmidt, 2011). A graphic organizer encourages the building of knowledge and the transformation of what a learner knows about a subject (Rotgans & Schmidt, 2011; Kolb & Kolb, 2009). The K-W-L chart promotes meaningful learning by prompting learners to identify previous knowledge and to consider what they want or need to know to enhance or complement that knowledge. As learners compare what they know and what they want to learn, they can also identify and clarify their own misconceptions and misunderstandings. By empowering the student, the K-W-L chart facilitates a personal connection to a new learning experience. A K-W-L chart has been shown to be effective for maintaining learner interest and to encourage active learning and reflection (Clapper, 2010; Ivey & Reed, 2011).
K-W-L CHART IN NURSING CLINICAL COURSES
Using the K-W-L chart in clinical practice courses is an active learning technique to facilitate application of classroom knowledge in the clinical setting and promote self-directed learning. The chart elicits the learner's knowledge about a clinical population or setting, identifies the learner's self-determined learning goals, facilitates seeking new knowledge, and documents the outcomes of the learning opportunity. Using a constructivist approach, students construct their own understanding and gain new knowledge through experiences.
Students do a K-W-L chart for each clinical day. Prior to the beginning of the clinical day, each student individually completes the K (know) and W (want to learn) columns of the chart. The know column is an area to "brain-dump" or write down what the learner knows about the patient population or specific patient condition students will be caring for during the clinical day. The learner's knowledge can be from multiple sources: didactic theory from classroom lectures, textbooks, or journals, as well as personal knowledge from prior experience or learning from family or friends. Students are asked to identify the source of the knowledge they bring to the clinical day. By writing down what they know, the knowledge becomes real, and many students are surprised by how much they actually know about the topic.
In the W (want to learn) column, students identify the gaps in their knowledge and what they want to learn from the day's clinical experience. These knowledge gaps or questions become learning goals to guide the clinical day. Goals that are not doable during the clinical day become areas for further study. Because the focus is on self-directed learning, the directions for completing the K-W-L chart are minimal. The only requirements are as follows:
K: This column includes a minimum of two things you "know" from class or assigned readings about patient care in this clinical setting. References for the source of this knowledge must be included.
W: This column focuses on enhancing cognitive knowledge and not just the performance of tasks or skills.
L: This column documents your learning outcomes by demonstrating how you applied your knowledge in the clinical setting and how you achieved your want-to-learn goals.
The chart, with the first two columns completed, is given to the faculty member before morning report. While the students are receiving report, the faculty member reviews the submissions and meets with students individually. The purpose of these meetings is to provide feedback and arrange for collaboration with the unit's nursing staff in order to identify patient care activities that will help meet the student's self-identified knowledge gaps and learning goals. Examples of students' content from the K-W-L chart for a maternal newborn clinical experience are illustrated in Table 1 (see Supplemental Digital Content, available at http://links.lww.com/NEP/A47).
As is evident in the table, some students exhibit a thoughtful consideration of didactic content and an intention to understand critical thinking processes in the application of theory in the clinical setting. Other students identify areas of learning more closely associated with curiosity or filling in the gaps from readings or lectures. At the end of the clinical day, the student completes the last column (learned) and describes what was learned during the clinical experience and how it builds on existing knowledge or raises new questions for continued learning.
The completed form is given to the faculty member who reviews it and provides feedback to the student prior to the next clinical day. The use of a K-W-L chart actively involves students in directing their learning during the clinical experience, culminating in a feeling of ownership of the knowledge obtained.
EVALUATION OF THE K-W-L CHART FOR CLINICAL LEARNING
The K-W-L chart has been used in this clinical course for three years and has been completed by approximately 120 junior-level students in a BSN program. The response of students and clinical agency staff has been highly positive. Clinical staff appreciate that students come to the experience with an ability to speak knowledgeably about patient care. Staff have also noted that students take more initiative in seeking learning opportunities and ask questions at the application level, as opposed to more fact-based questions. In the past, if a patient was in pain, the student may have asked the nurse, "What medication are you going to give her?" Now the student is more likely to ask, "How do you decide which medication to give her?"
Students also find the K-W-L chart beneficial. The following comments about the K-W-L chart were shared by students as part of the final course evaluation: "I want to continue to develop my critical thinking skills. The K-W-L form was a useful exercise and I plan to continue to use it to be prepared with questions prior to my next clinical course" and "Usually I go to clinical and do whatever I am told to do. After completing the K-W-L chart, I arrive more aware of what I already know and what I want to learn that day. I was better able to ask for opportunities to learn as opposed to waiting for someone to teach me."
From the perspective of the faculty member, the K-W-L chart provides a vehicle for students to make their thinking visible and to place emphasis on the cognitive component of nursing practice, not just the doing of technical skills. There is a visible shift from students coming to clinical with the goal of "seeing" what is done to "understanding" why it is done. Faculty feedback to the student is essential to move all learners to a cognitive level of learning while incorporating the practice of nursing skills and tasks. Using the K-W-L chart provides an opportunity for collaboration with nurses to identify opportunities to fulfill the students' learning goals. Finally, the chart shifts the responsibility for documenting learning outcomes to the student, which is helpful in writing end-of-clinical evaluations.
CONCLUSION
Nursing education consists of both theoretical and practical elements. The K-W-L chart is a student-directed and active learning strategy to guide students in bringing together the theoretical and practical elements on their journey to becoming independent critical thinkers and decision-makers. Clinical reasoning and decisional capability are significant parts of learning to think and to act as a nurse. The K-W-L chart is a means to promote these behaviors and show the students' growth in the integration and application of knowledge in the clinical setting. This educational strategy has been positively received by students, clinical agency staff, and faculty as a tactic to bridge the theory-practice gap.
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