Objectives and Outcomes- The Fundamental Difference

8/12/2019 Objectives and Outcomes- The Fundamental Difference

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Ju ly / Au gu st 20 10 Vol .31 No .4233

O B J E C T I V E S A N D O U T C O M E S

A B S T R A C T This discussion focuses on the difference between educational objectives and outcomes. Both terms are used in nursing edu-

cation, many times for the same purpose, yet they are expressions of different educational paradigms. A historical view of the development of

objectives and outcomes is provided as well as a description of each. The discussion concludes with a demonstration of formats for develop-

ing educational outcomes.

Objectives and Outcomes: The Fundamental DifferenceR U T H A . W I T T M A N N - P R I C E A N D B R I A N J . F A S O L K A

OMPREHENSIVE INITIAL AND ONGOING

EDUCATION IS ESSENTIAL FOR ALL REALMS OF

NURSING PRACTICE, EDUCATION, AND RESEARCH.

Whether the process takes the form of in-services for estab-

lished nurses, academic sessions for nursing students, mul-

tidisciplinary professional research presentations, or patient

teaching, education is a vital part of the nursing role.

Traditionally, nurses have been taught to start all educational

or teaching/learning sessions by stating the objectives, a

practice that provides a clear understanding of the purpose

of the session and serves to clarify the teachers expecta-

tions. The learners changed behavior is evaluated after the

completion of the session to demonstrate that learning took

place. As stated by Rankin and Stallings (2001), Objectives

describe behaviors that the learner will perform to meet a

goal (p. 240).

Our current, economically driven health care environment

focuses on outcomes of care. In response, nursing education

has interposed outcomes of learning for objectives of teaching

(Morin, 2007; Partusch, 2007). The educational literature has

also long spoken to outcomes rather than objectives. The cen-

tral focus is to redirect the teaching/learning process and

bring about a closer link to the learner. This also aligns better

with professional practice, where outcomes promote quality

improvement (Glennon, 2006).

This shift in thinking, from objectives to outcomes, has

been cited as a paradigm shift and, indeed, there are theoret-

ical differences. Many nurse educators who are not fully aware

of the underlying impetus for the change wonder why wording

has changed in courses that have no change in context or con-

tent (Morin, 2007). Some see this trend as a linguistic game,

with the word outcome substituted for the word objective in

order to maintain political correctness (Schwarz & Cavener,

1994). Prideaux (2000) called this phenomenon the emper-

ors new clothes in medical education.

Relevance How we frame what we, as nurses, teach and whatour recipients (other nurses, professionals, students, or

patients) learn should be more than just a linguistic exercise.

It affects the teaching/learning process and ultimately affects

application to patient care. Because of its importance and

societal contribution, the framing of the teaching/learning

process needs theoretical thought.

Reviewing the standard definitions of the words objective

and outcome further reveals the essential difference

between the two concepts. An objective speaks to the

process and the goal. Therefore, it is teacher and student

focused. An outcome, a final product or end result, speaksto the goal, so its focus is the student, because learning is

the goal for the student.

The obvious reason that objectives or outcomes still exist

and persist in education is that they are thought to be parsi-

monious enough to capture the complexity of the

teaching/learning process. Many educators believe they have

the simplicity and practicality needed for mapping out and

evaluating understanding of what is to be learned.

Historical Development For many years, objectives were

presented as the essential foundation of any educational

endeavor in nursing education and were elevated to the position

of guiding light for both the process of teaching and the end

result of the learning. Objectives were used for all activities that

took place within a classroom, course, session, or curriculum

(DeYoung, 2003). Well defined learning objectivesare stated

so that expectations are clear to the student (de Tornyay &

Thompson, 1982, p. 150). Education has used objectives for

student learning since Tylers (1949) landmark book encour-

aged educators to develop objectives to frame their teaching

(Reilly & Oermann, 1999).

According to Prideaux (2000), Tyler intended to keep objec-

tives broad in nature; they were modified by others to conform

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234 Nursing Education Perspectives

to behaviorism and standardization. The form in which objec-

tives emerged was usually a three-part statement that included

the behavior, condition, and standard of the teaching/learning

process. Educators adapted objectives and even prepackaged

them for educators to avoid errors in their development

(Prideaux). The criteria that heralded a good objective werespecificity and measurability, and these have been carried over

to outcome development.

Action verbs outlined by Bloom and colleagues were used in

composing objectives to specifically describe expected behav-

iors of the learner. Blooms taxonomy (Bloom, Englehart, Furst,

Hill, & Drathwohl, 1956) uses behavioral terms to divide learn-

ing into leveled achievements, from knowledge acquisition

(understanding) to the synthesis (creating) of new ideas

(Krathwohl, 2002). Behavioral terms were further categorized

into three domains (cognitive, psychomotor, and affective),

underscoring the presence of the art, science, and practice ofnursing. Gagne (1970) also described objectives as the second

event in the nine steps to instruction, thus reinforcing the need

for them.

Objectives presented a method to logically organize a teach-

ing session or course and provided criteria for evaluation that

allowed for grading justification (Novotny & Griffin, 2006).

Using objectives served its purpose well, organizing the teach-

ing/learning process while the discipline of nursing was in its

growing stage of intense curriculum development (Parker,

2005). Developing and meeting objectives were important;

objectives were used by educators and accrediting organiza-

tions to evaluate an individuals or organizations teaching effec-

tiveness (Billings & Halstead, 2009).

Anderson et al. (2001) suggested that a higher learning

domain, metacognition, be included to encompass aspects of

critical thinking spurred by reflection. Metacognition is used

along with the terms factual, procedural, and cognitive to

encompass all aspects of knowledge acquisition. Investigation

of methods to enhance metacognition is needed in nursing edu-

cation to foster appropriate knowledge development and deal

effectively with the information-driven health care environ-

ment. Teaching methods to increase metacognition, such as

concept mapping, have been shown to be successful (August-Brady, 2005).

Paradigm Shift As the health care environment changed to a

forum regulated by cost expenditure versus human risk, out-

comes became more important. In the clinical arena, outcomes

are evaluated in terms of dollars and cents, health achievement,

patient safety effectiveness, or educational productivity, and the

question is asked: Does the outcome justify the resources used?

Outcome-based education (OBE) began in the 1980s and grew

in popularity in the 1990s (Spady, 1988; Harden, Crosby, Davis,

& Friedman, 1999). It has its historical roots in competency-

based education, which originated in the 1960s (Schwarz &

Cavener, 1994). Harden, Crosby, and Davis (1999) used the termperformance-based education, where the emphasis is the product

and focus is always the end result. Spady described OBE as a

way of designing, developing, delivering, and documenting

instruction in terms of intended goals and outcomes (p. 2).

Nursing education has adopted outcome expectancy, or OBE,

which considers the learning experience as delivering the prod-

uct or knowledge needed by the student, patient, or nurse. The

process is no longer the priority in the learning; this, hopefully,

has opened the door to many creative teaching methodologies.

The outcome, what the student, patient, or colleague will cogni-

tively, skillfully, or affectively demonstrate by the end of theexperience or lesson, is most important.

It is important to note that the paradigm shift removed the

focus from the teacher and extended the responsibility of learn-

ing to the learner. One criticism is that this paradigm shift has the

potential to squelch learning for pure knowledge and personal

growth, and sometimes, not always, implicates that the outcome

must be directly applicable. Morin (2007) provides a good expla-

nation of the current general understanding of the difference

between objectives and outcomes, stating that outcomes reflect

the students performance in relation to objectives (p. 251).

In a simple analogy, OBE can be compared to a vacation. An

outcome-based trip would choose the destination first, then

research the modes of transportation to get to the chosen point.

A vacation planned on objectives would plot the specificities of

the route as well as the mode of transportation.

Operationalization of the Paradigm So how do we oper-

ationalize the difference between behaviorally written objec-

tives and learning outcomes? The differences are slight in

language but can represent a large change in conceptualization,

depending on the educators understanding and the educational

culture in which they are used.

Both objectives and outcomes use behavioral terms andextend the principles set forth by Tyler (1949) and others

(Bloom et al., 1956). The lead-in sentence is usually altered in

a teaching/learning session from the student will for objective

writing to at the end of this session, the student will be able to

for outcome formatting. As Prideaux (2000) states, It is diffi-

cult to explain the difference between a significant and worth-

while objective and a well-written and well-defined outcome



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Ju ly / Au gu st 20 10 Vol .31 No .4235

(p. 169). Outcomes and objectives are both still expected to

describe the learner, the behavior, and the content.

Changing from objectives to outcomes is truly more of a

conceptual than an operational change. Some nurse educa-

tors have just switched words and not thought processes.

Others believe that neither objectives nor outcome gives usthe freedom needed to encourage learners to think critically.

Neither captures the aha moments of learners or the cre-

ativity that is encouraged in the class and clinical arenas.

The current learner-centered paradigm of nursing education

calls for a more fluid framework than either objectives or out-

comes can provide. Outcomes are slightly less restrictive in

the learning environment, a positive move toward an educa-

tional process that is more emancipatory (Freire, 1970;

Schreiber & Banister, 2002).

Future ParadigmsBecause people rarely learn somethingusing just one learning domain, the use of objectives in nursing

education was rightfully questioned by forward thinkers such as

Diekelmann (1997) and Bevis and Watson (1989). Also, the

idea that learning or knowledge acquisition can always be

demonstrated in behavior is not realistic. Diekelmann, Bevis,

and Watson understood that all learning is not displayed in

behavior, and that by predetermining learning with objectives

or outcomes, we may be squelching the depth and breath of the

learning experience. The notion that a piece of information can

be categorized in a knowledge level from simple recall to

synthesis makes it simplistically exclusive. Objectives and

outcomes tend to keep learning linear and isolated in catego-

rizations hinged on observable behaviors. In the behaviorist

paradigm, the behaviors the student displays that are the tes-

timonial that learning took place may not capture the thought

processes or thinking ability of the learner.

It is difficult, at best, to package the human intellect into

a modifiable mold for convenience in grouping, evaluating,

and justifying what is being taught or presented, or what the

learner carries forth from the experience. Nursing education,

as a practice discipline, is even more fraught with categoriza-

tion difficulties because it has an application component dis-

played in the practice. The application of knowledge does notalways coincide directly with the theoretical portion sequen-

tially because of the holistic nature of the profession. The

nursing art of caring and caring for is much greater than the

educational parts when they are separated into components

(Dunn, 1991).

Can we ever predict what is learned? Can we assess what is

learned from overt behavior? Can we state exactly what we are

going to teach? Maybe we can state the concepts or topics that

we will focus on in a session, but what we teach is perceived dif-

ferently by each learner, and what is learned from different per-

ceptions is not always categorically definable. Knowledge is a

complex concept in itself, but in order to turn out safe practi-

tioners and to provide ongoing education in the discipline ofnursing and to provide safe information to the public, specific

knowledge must be mastered at some level of comprehension.

That mastery of information (for lack of better description) must

be measured, which is what is attempted through outcome

development.

How to Develop Learning Outcomes So, with all that

being said, young educators still need to know how to write

learning outcomes as opposed to objectives. Harden, Crosby,

and Davis (1999) listed criteria that outcomes should meet:

reflect the mission and be clear, specific, manageable in num-ber, appropriate for the level of the learner, progressive, and

related.

Nursing education has available several good resources that

explain how to write outcomes to meet these criteria. (Examples

are provided in the Figure.) One, from Florida State University

(2007), provides instruction by using the A-B-C method. The

A stands for antecedent or the learning activity; B stands

for behavior or the skill or knowledge being demonstrated; and

C stand for the criterion or the degree of acceptable perform-

ance. (Example A in the figure is compared to an objective in

Example B.)

Figure. Writing Outcomes

EXAMPLE A

(A) By the end of this session the learner will be able to:

(B) Demonstrate sterile Foley catheter insertion (C) 100% of the time in

clinical.

EXAMPLE B

This learner will:

demonstrate (verb) sterile Foley catheter insertion in clinical by return

demonstration (content or context).

EXAMPLE C

Antecedent / By the end of this session

Learner / the nursing student will

Verb describing behavior / demonstrate

Content / Sterile Foley catheter insertion

Context / in clinical

Criteria / 100% of the time



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236 Nursing Education Perspectives

Other outcome instructions include a slightly different three-

step process that includes verb, object, and context (Kahn,

2003). Here the criteria are not stated specifically. Some instruc-

tions even provide a template to assist the educator to develop

appropriate learning outcomes (Florida State University, 2007).

An example of an adapted template, which includes all the men-tioned components of a learning outcome, is shown in example

C in the figure. To check your outcomes, ask this question: Is it

observable and measurable, achievable, and meaningful?

(California Department of Health Services, 1998).

Formatting any abstraction always runs the risk of stifling

creativity, so a conscious effort must be made to keep the goal

of the outcome in mind. What is the product that you want

to produce at the end of this learning experience? Until an

entirely new paradigm takes hold in nursing education, out-

come-based education needs to work for those educators who

are currently entrenched in nursing education. Understanding

historical development, underpinning philosophies, definitions,

and structural mechanisms helps empower educators by devel-

oping self-efficacy in the educational process.

About the Authors Ruth A. Wittmann-Price, PhD, RN, CNS,CNE, was assistant professor and coordinator for the education

track at Drexel University, Philadelphia, Pennsylvania, when this

article was written. She is now head of the nursing program at

Francis Marion University, Florence, South Carolina. Brian J.

Fasolka, MSN, RN, CEN, is an assistant clinical professor at Drexel

University College of Nursing and Health Professions. Contact Dr.

Wittmann-Price at [email protected].

Key Words Objectives Outcomes Metacognition Teaching and

Learning

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Objectives and Outcomes- The Fundamental Difference

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