Lifelong Learning Theory

MAN 600
Philosophical Foundations in Nursing with Theory Construction and

Development of Concept Paper
by
Jallen Jimenez
Earl Vincent Salongcay
Madel Teodosio
Gerald Dave Villorente
Presented to
DR. CHARLIE D. BALDON
Professor
MAN 600 - Philosophical Foundations in Nursing with Theory Construction and Development of Concept Paper
Transformation involves every aspect of a professional nurses’ life.
Health professionals are expected to be creative, critical thinkers who can
respond to the dynamic health and social care environment. As they
frequently encounter new and changing health care roles, technological
advances, on-going reorganization and the constant redirection of resources
they are constantly required to adapt and develop the ways they meet the
varied needs of patients and their careers. ‘Learning to learn’ and ‘learning to
practice’ are therefore essential for good clinical practice.
Lifelong learners are innovative, responsive, resourceful, adaptable,
challenging, creative, self-reliant, responsible and accountable change agents
who are able to share their knowledge with others, and act as credible role
models in practice. In order to do this, they need to take responsibility for
their own learning and development, and possess a range of skills that can
be used for identifying, accessing, retrieving, filtering and applying the
information they need to do their work better. Critically for lifelong learners,
this includes the possession of information seeking and problem-solving
skills. In order to become a lifelong learner, as you develop professionally, it
is necessary to invest adequate time and energy to take a deliberate,
conscious and focused approach to personal and professional learning needs.
This might take the form of a structured ‘SWOT’ analysis, looking at strengths
and weaknesses, opportunities for personal and professional development,
COGNITION TO SERVICE: A Theory on Continuing Education and Professional Development in Nursing 1

and any threats to these, such as work or family commitments. Once this is
done, lifelong learners will know where they are heading, and can seek out
appropriate sources of information or training.
One approach to conceptualizing lifelong learning claims it is
concerned with promoting skills and competences necessary for developing
general capabilities and specific performance in work situations. Skills and
competences developed through programs of lifelong learning are vital for
workers’ performance in their tackling of precise job responsibilities and how
well they can adapt their general and particular knowledge and competences
to new tasks.
Upon entering practice, the health care professional experiences
increased demands that reduce the time available for learning and
assessment, and over time the professional’s knowledge of emerging
evidence-based practice and professional competence may deteriorate.
Excellence in nursing is about developing one’s knowledge and skills to stay
abreast of the rapid changes in the field. Lifelong learning – the process by
which nurses acquire new skills and competencies, and update their interests,
abilities, knowledge and qualifications – is key. The arrival of lifelong
learning within nursing constitutes a major conceptual shift that every
qualified nurse is expected to adopt to be able to function as a Registered
Nurse (RN) throughout their career.

The ultimate goal of Lifelong Learning Theory is to bridge the gap
between nursing theory and clinical practice and delivering care which is
truly evidence-based. Creating an expectation and culture of lifelong
learning for nurses is aimed and deemed essential for quality nursing care.
LIFELONG LEARNING and LIFELONG LEARNERS
Lifelong learning is the development of human potential through a
continuously supportive process which stimulates and empowers individuals
to acquire all the knowledge, values, skills and understanding they will
require throughout their lifetimes and to apply them with confidence,
creativity and enjoyment in all roles, circumstances, and environment.
Lifelong learning allows for development of critical thinking and supports
introspection and detail in client care. A requisite to lifelong learning is not
a cognitive capacity to learn, but the ability to recognize and understand
information. Beyond this ability, the desire to learn, based on confidence in
being able to conceptually infer, evaluate and appreciate what is learned is
required.

Lifelong learners are individuals motivated to go beyond in-service
seminars and mandatory orientation to a place of personal and professional
gain. Independence (self-direction) as a learner can be an attribute of
successful lifelong learning. This independence is built on confidence,
patience, persistence, diligence, and attention to detail. It can be agreed upon
that the need for independent thought and add that lifelong learning also
includes actively seeking a variety of sources in order for the learner to make
informed choices. Defining lifelong learning and determining the
characteristics of a lifelong learner are necessary to determine how to foster
this attribute which is deemed so important to the profession of nursing.
NURSING COMPETENCE
The changing healthcare system and changing roles of nurses within
that system increase the risk in day-to-day practice. Maintaining professional
competence is key to managing risk and lifelong learning is essential to
maintaining professional competence.
Continuing competence contributes to the quality of nursing practice.
Continuing competence enables nurses to base their practice on the most
recent and strongest evidence necessary to produce high-quality client
outcomes, assist in preventing poor practice and protect the public. One way
nurses can obtain, maintain and continuously enhance their competence is
through lifelong learning. Continuous learning requires nurses to reflect on
their competencies in relation to the changes occurring in society and the

health-care environment and, as a result of that reflection, take action to
acquire and develop new competencies. Continuing nursing education
develops and enhances competencies significantly.
QUALITY NURSING CARE
Quality of nursing care is a multidimensional concept which is difficult
to define or measure. Patients and nurses hold different meanings in relation
to quality nursing care. Despite the different understandings between nurses
and patients two aspects of the care are found common, that is being cared
for by competent nurses and addressing the patient' s needs. The concept of
quality nursing care is delineated as the outcome of integrating skills and
competency acquired through lifelong learning activities by nurses providing
care.

ASSUMPTIONS
 Only lifelong learning skills can take any theory, framework or concept
and apply it to current practice, thus closing the gap between theory
and practice and delivering care which is truly evidence-based.
 Lifelong learning involves the ability to resolve issues through inquiry,
resource identification, and independent/continual assessment of
one’s own learning needs.
 Lifelong learning promotes skills and competences necessary for
developing general capabilities and specific performance in clinical
situations.
 The atmosphere of lifelong learning aids in gaining the competencies
needed to provide care for diverse populations across the lifespan.
 Lifelong learning allows for development of critical thinking and
supports introspection and detail in client care.
 Lifelong learning is central to the concept of professionalism.

MODEL
Quality
LIFELONG Nursing
Nursing Care
LEARNING Competence
Delivery
PROPOSITIONS
 This theory proposes that nurses should engage in lifelong learning,
and further, that healthcare organizations and schools of nursing create
a culture of lifelong learning.
 The best way to become a lifelong learner is to participate in a suitable
‘study skills’ course which can be provided in many formats – on-line,
face to face, self-directed or even delivered as a handbook.
 This theory suggests that it is important that professional nurses
should not feel forced to be lifelong learners but should rather take the
responsibility for upgrading their competence and realize the value of
doing so.
 Professional nurses should consider the utilization of lifelong learning
scheme as their framework in providing effective nursing care.

PERSON
Man/Person refers to nurses having varied learning needs in providing
patient care. They are life-long learners that are required to enhance and
update their knowledge and skills in terms of clinical practice.
ENVIRONMENT
The theory views environment as the ever changing trend and
expansion of the scope of nursing roles. Lifelong learning considers
continuing education and professional development of nurses as an external
factor that positively impacts the patient’s health.
HEALTH
Health refers to the adaptive response of patients nurses with acquired
skills and knowledge through the endless pursuit of lifelong learning. The
primary goal is to improve the status and condition of the patient through
those skills and knowledge, therefore, achieving optimal health.
NURSING
Lifelong learning in nursing is defined as a dynamic process, which
encompasses both personal and professional life. This learning process is
also both formal and informal. Lifelong learning involves seeking and
appreciating new worlds or ideas in order to gain a new perspective as well
as questioning one's environment, knowledge, skills and interactions. The

most essential characteristics of a lifelong learner are reflection, questioning,
enjoying learning, understanding the dynamic nature of knowledge, and
engaging in learning by actively seeking learning opportunities. Keeping the
mind active is essential to both lifelong learning and being able to translate
knowledge into the capacity to deliver high quality nursing care.
PRACTICE
Lifelong learning practices such as continuing Education has been
debated as an important process in learning due to the unexpected growth in
professional knowledge, rapid changes in the healthcare system and the
changes in nurses’ roles. Dramatic advances and transformations in
healthcare organizations contributed to the need of adjustment among the
healthcare practitioners as it is a professional necessity to maintain
competence and to safeguard the public in facing the issues of expansion in
technology, consumer request for quality care, pressure for cost
containment, increased patient acuity and complexity in disease.
Globalization, technological advances, consumerism and climate changes
have challenged the health care environment to ensure practice and services
are contemporary. Continuing Education programs is a good practice for
nurses within the nursing practice environment. This is relevant to assist
nurses to reflect on their roles and functions, where knowledgeable nurses

have an ability to show their competency and effectiveness as a nurse.
Continuing education can also facilitate nurses to minimize errors, produce
a nurse that has the ability to provide safe and quality patient care and to
support the nurses in decision-making.
EDUCATION
Nurses should continue learning throughout their careers. They need
to stay up-to-date on patient care, healthcare trends, treatments and
techniques. NPD specialists are available to advise nurses about certification
and licensing requirements, and they can also address a nurse’s need for
additional instruction. Furthermore, NPD specialists ensure that the nurses
under their supervision always demonstrate competency.
The Robert Wood Johnson Foundation (RWJF) began an initiative on
“The Future of Nursing” in 2008. The Institute of Medicine (IOM) published
“The Future of Nursing: Leading Changes, Advancing Health” report in 2010
based on the RWJF initiative. (The IOM changed its name to the National
Academy of Medicine (NAM) in 2015.)
According to an ANPD white paper titled Role of Nursing Professional
Development in Helping Meet Institute of Medicine’s Future of Nursing
Recommendations, the 2010 IOM report emphasized the “importance of
preparing students for a career in nursing at the associate, baccalaureate and
graduate levels. Equally important, the committee recognized that the
recruitment and retention of well-prepared nurses across the healthcare
continuum depends on providing nurses with opportunities to improve

competencies and skill. The complexity of the current healthcare system
requires increasing specialization of nurses. Nurses who are initially well
prepared and continue to develop professionally throughout their career are
a key factor in obtaining positive patient outcomes.”
The report concluded that professional development is essential for
excellence in healthcare. The report also stated that nurses who receive
mentoring have a greater chance of becoming leaders in their profession.
RESEARCH
“LIFELONG LEARNING THROUGH CONTINUING EDUCATION”

AMERICAN NURSES CREDENTIALING CENTER
The tables below describe 9 research studies of continuing education linked to patient
outcomes, changes in behavior or practice, and changes in knowledge. Outcome
measures such as safety climate are included as potential precursors to changes in
behavior or practice.
Table 2. Changes in Patients Outcomes

Study Continuing Education Outcomes
Ammentorp et al. a 3-day training course significantly increased
(2010) – 32 healthcare on communication proportion of parents
professionals, skills for eliciting and post-course satisfied
including 25 nurses, responding to patient with 4 of 13 questions
895 parents pre-course, concerns and needs on care and continuity
and 1937 parents post- no significant change in
course, from a proportion of parents
department of satisfied with 9
paediatrics in a regional questions on
hospital in Denmark information
Pridham et al (2006) – 28 classroom hours on no difference in
public health nurses: 11 supporting families to mothers self-
experimental, 116 develop caregiving assessment of
control; patients: 12 competencies through caregiving competency
mothers of Very Low guided participation most experimental
mothers rated selves as

Birth Weight (VLBW) satisfied with guided

babies, 4 controls participation
Zurmehly (2013) ‒ 44 30-minute online self- post-intervention
nurses and 180 patients study module and reduction in rates of
in a hospital in the study materials in an ventilator-associated
Midwest educational toolkit for a pneumonia
nursing intervention of
oral care for
mechanically ventilated
ICU patients
Table 3. Changes in Behavior or Practice

Weitzel et al. (2011) ‒ 12-minute video improvements at 6-
staff from 5 units and scenario, distributed month follow up in
166 observations of via staff meetings and observed frequency of
staff-patient nursing unit council use for 5 of 8
interactions (86 pre- meetings, on the use of appropriate
and 80 post- inappropriate and communication
intervention) in a appropriate techniques
medical center in communication
Illinois techniques with
hospitalized elderly
patients with dementia
Stecker & Stecker (2012) 4 45-minute sessions better posttest scores
‒ 25 nurses in a hospital using presentation, measured by rater
in the Northeast discussion, and case evaluations of
based scenarios on videotaped assessment
nursing assessment of and patient interaction
patients admitted to in 2 of 7 areas:
epilepsy monitoring  neurological exam
units  respect
King et al. (2007) --98 4 90-minute sessions post-training
RNs at a over a year on effective improvements in
diseasemanagement patient teaching and teaching scores
company call center in problemsolving evaluated by trained
the Southeast coder audits of
interactions with
clients

Table 4. Changes in Knowledge

Gesin et al. (2012) – 20 introduction of a increased agreement
surgical-trauma ICU delirium screening tool between participating
nurses in a hospital in and multifaceted nurses and
North Carolina education including independent judges on
pharmacist-led didactic assessment of delirium
lecture, web based among patients
module, and nurse-led
bedside training
Nellis & George (2012) ‒ short online self-study larger posttest
45 advanced practice module on medical proportion of
nurses enrolled in a malpractice participants
doctor of nursing responding correctly to
practice program knowledge questions
Spiva et al. (2012) ‒ 135 instruction in better posttest scores
nurses in 5 hospitals of interpretation of basic for all groups on an
an integrated electrocardiogram American Heart
healthcare system in strips using 5 different Association online
the Southeast teaching modalities electrocardiogram
(instructor-led course, rhythm test
e-learning with and
without study time,
elearning plus
facilitated debriefing
with and without study
time)

The characteristics of the theory will be evaluated employing Fawcett’s

Theory Evaluation.
Fawcett (2000) made the following recommendations to be used for the
evaluation of nursing theories. Her criteria include significance, internal
consistency, parsimony, empirical adequacy and pragmatic adequacy.
SIGNIFICANCE
The theory addressed the metaparadigm concepts and propositions

clearly. Though the theory is a middle-range theory, it attempted to cover all
aspects of the metaparadigm. The authors knowledge from nursing and
adjunctive disciplines were acknowledged.
INTERNAL CONSISTENCY
All elements of the theory are found to be congruent. The elements

include conceptual model, theory concepts and propositions. Semantic
clarity and structural consistency were maintained and observed in this
theory to satisfy internal consistency.
PARSIMONY
Parsimony is concerned whether the theory is stated clearly and

concisely. Since it is a middle-range theory that only focuses on the topic of
lifelong learning and its outcomes, the statements proposed clarify rather
than obscure the topic of interest. Although the scope of the theory may be
narrow, it is still important to be clear and concise in the explanations of the
concepts.

EMPIRICAL TESTING
The goal of theory development in nursing in empirical testing of

interventions are specified in the theory. The concepts are observable and
propositions are measurable through development of instruments.
EMPIRICAL ADEQUACY
The assertions made by the theory are congruent with empirical

evidences found through studies using the concept in research. The end
result of using empirical adequacy is to establish the level of confidence in
the theory from the best studies yielding empirical results. The theory’s
assertions are harmonious with the discovered research studies’ empirical
result.
PRAGMATIC ADEQUACY
This criterion evaluates the extent of how well the middle range theory
is utilized in the clinical practice. The authors fully understand the whole
content of the theory. The theory helps move resulting nursing action toward
favorable client outcomes.

SAFE AND QUALITY NURSING CARE
Through this theory, the nurses are guided with updated knowledge
and skills. The nurse can implement safe and quality nursing interventions
addressing health needs, problems and issues when continuing education is
considered. They have the capability to apply quality and safety improvement
approaches in care.
MANAGEMENT OF RESOURCES AND ENVIRONMENT
Pursuing continuing education such as nursing informatics enables the

nurse to understand, value and use informatics to all areas of health care, to
reduce errors, manage knowledge and information, and make decisions and
communicate.
HEALTH EDUCATION
Nurses who engages themselves in lifelong learning can identify

healthcare issues and help you stay current in the latest evidence for new
practices and quality indicators through learning activities, in-services, and
information-sharing.
LEGAL RESPONSIBILITY
Knowledge and skills gained through lifelong learning will enable the
nurse to participates in the development of policies and standards regarding
safe nursing practice.

ETHICO-MORAL RESPONSIBILITY
It is ethically proposed that nurses have the responsibility to subject

themselves in lifelong learning in order to grow professionally and provide
quality nursing care.
PERSONAL AND PROFESSIONAL DEVELOPMENT
Nurses should continue learning throughout their careers. They need

to stay up-to-date on patient care, healthcare trends, treatments and
techniques.
QUALITY IMPROVEMENT
Professional development is essential for excellence in healthcare.

Lifelong learning enhances the knowledge of the nurse thereby possessing
the ability to provide better nursing care.
RESEARCH
New and developing trends creates a venue for clinical studies and
exploration. Research in lifelong learning such as in continuing education
helps develop criteria and standards of effective care delivery.
RECORDS MANAGEMENT
Regularly improving the skills and knowledge or enrolling in courses of

nursing informatics improves the ability of the nurse to properly store and
manage hospital data and records.
COMMUNICATION
The best expertise training and continuing education of nurses in

matters relating to the proper technique of communication will enable them
to respond adequately and humanely to the expectations of patients.

COLLABORATION AND TEAMWORK
The continuing professional development has become an

unquestionable target in today’s society. This concept encompasses
processes of reflection, interaction with the surrounding environment, and
collaboration, aiming at relevant formative paths and the continuous
personal and professional update. From this perspective, collaborative
supervision is based on interaction, mediation between the supervisor and
the supervised, and the sharing of fundamental knowledge, experiences and
objectives in the current context of lifelong training in nursing.

In essence, the nursing profession has very much been around since
the beginning of time, though has drastically evolved over the course of
history. Today, nurses are one of the most important professions within the
health care industry and are learned in a wide range of occupational duties
that are utilized within a variety of settings throughout the world.
Florence Nightingale, throughout her “Notes on Nursing,” speaks to the
fact that nurses must learn constantly, not only through observation and
experience but also by seeking new knowledge and new evidence. She was
quick to recognize that the accepted way of doing things was not always the
best and strived to discover new ways to care for patients and create healthy
environments. This is no less true today. A commitment to lifelong learning
is a professional responsibility that nurses owe to themselves and to their
patients if excellence in practice is to be achieved.
Nursing is a constantly developing profession. Nurses must maintain
confidence and remain open to collaboration and evaluation to attain the best
patient care. For a lasting and thriving career, nurses should commit to
improving their skills through lifelong learning.

 Edelson, Mat, “Lifelong Learning,” Johns Hopkins Nursing, November 29,

2012, accessed at http://magazine.nursing.jhu.edu/2012/11/ lifelong-
learning/.
 Institute of Medicine (US) Committee on the Robert Wood Johnson
Foundation Initiative on the Future of Nursing, at the Institute of Medicine,
“The Future of Nursing: Leading Change, Advancing Health,” National
Academies Press (US); 2011.
 Josiah Macy Foundation, American Association of Colleges of Nursing (AACN)
and the Association of American Medical Colleges (AAMC), “Lifelong Learning
in Medicine and Nursing Final Conference Report,” 2010.
 Novak, Malorie Kosht, PT, PhD, DPT, et al., “Measuring Health Professions
Students’ Orientation Toward Lifelong Learning,” Journal of Allied Health,
Fall 2014, Vol 43, No 3.
 Walston, Stephen L., PhD, and Amir A Khaliq, PhD, “The Importance and Use
of Continuing Education: Findings of a National Survey of Hospital
Executives,” The Journal of Health Administration Education, Spring
2010.Gopee, Luxmi Narainsingh (2003) The nurse as a lifelong learner: an
exploration of nurses' perceptions of lifelong learning within nursing, and of
nurses as lifelong learners. PhD thesis, University of Warwick.
 http://www.nursecredentialing.org

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MAN 600

Philosophical Foundations in Nursing with Theory Construction and

Transformation involves every aspect of a professional nurses’ life.

Health professionals are expected to be creative, critical thinkers who can

respond to the dynamic health and social care environment. As they

frequently encounter new and changing health care roles, technological

advances, on-going reorganization and the constant redirection of resources

practice’ are therefore essential for good clinical practice.

Lifelong learners are innovative, responsive, resourceful, adaptable,

challenging, creative, self-reliant, responsible and accountable change agents

models in practice. In order to do this, they need to take responsibility for

be used for identifying, accessing, retrieving, filtering and applying the

this includes the possession of information seeking and problem-solving

skills. In order to become a lifelong learner, as you develop professionally, it

is necessary to invest adequate time and energy to take a deliberate,

conscious and focused approach to personal and professional learning needs.

and weaknesses, opportunities for personal and professional development,

COGNITION TO SERVICE: A Theory on Continuing Education and Professional Development in Nursing 1

appropriate sources of information or training.

One approach to conceptualizing lifelong learning claims it is

concerned with promoting skills and competences necessary for developing

general capabilities and specific performance in work situations. Skills and

competences developed through programs of lifelong learning are vital for

workers’ performance in their tackling of precise job responsibilities and how

Upon entering practice, the health care professional experiences

assessment, and over time the professional’s knowledge of emerging

evidence-based practice and professional competence may deteriorate.

Excellence in nursing is about developing one’s knowledge and skills to stay

abilities, knowledge and qualifications – is key. The arrival of lifelong

learning within nursing constitutes a major conceptual shift that every

qualified nurse is expected to adopt to be able to function as a Registered

Nurse (RN) throughout their career.

COGNITION TO SERVICE: A Theory on Continuing Education and Professional Development in Nursing 2

The ultimate goal of Lifelong Learning Theory is to bridge the gap

truly evidence-based. Creating an expectation and culture of lifelong

LIFELONG LEARNING and LIFELONG LEARNERS

Lifelong learning is the development of human potential through a

continuously supportive process which stimulates and empowers individuals

require throughout their lifetimes and to apply them with confidence,

creativity and enjoyment in all roles, circumstances, and environment.

Lifelong learning allows for development of critical thinking and supports

introspection and detail in client care. A requisite to lifelong learning is not

a cognitive capacity to learn, but the ability to recognize and understand

information. Beyond this ability, the desire to learn, based on confidence in

being able to conceptually infer, evaluate and appreciate what is learned is

COGNITION TO SERVICE: A Theory on Continuing Education and Professional Development in Nursing 3

Lifelong learners are individuals motivated to go beyond in-service

seminars and mandatory orientation to a place of personal and professional

gain. Independence (self-direction) as a learner can be an attribute of

successful lifelong learning. This independence is built on confidence,

patience, persistence, diligence, and attention to detail. It can be agreed upon

informed choices. Defining lifelong learning and determining the

characteristics of a lifelong learner are necessary to determine how to foster

this attribute which is deemed so important to the profession of nursing.

The changing healthcare system and changing roles of nurses within

that system increase the risk in day-to-day practice. Maintaining professional

competence is key to managing risk and lifelong learning is essential to

maintaining professional competence.

Continuing competence contributes to the quality of nursing practice.

Continuing competence enables nurses to base their practice on the most

recent and strongest evidence necessary to produce high-quality client

nurses can obtain, maintain and continuously enhance their competence is

through lifelong learning. Continuous learning requires nurses to reflect on