When Experience Is the Obstacle: Transformative Learning and Teaching Experienced Nurses to Change a Long-Held Practice
Student Name
Master of Science in Nursing Program, Aspen University
N582: Teaching Strategies in Nursing Education
Instructor Name
Month Day, Year
When Experience Is the Obstacle: Transformative Learning and Teaching Experienced Nurses to Change a Long-Held Practice
On the adult medical unit of a composite community hospital, the night shift has taken full vital signs on every patient at midnight and 4 a.m. for as long as anyone can remember, including stable patients recovering from minor procedures who are woken twice a night. When the hospital's sleep committee proposed an order that would allow stable patients to sleep through the night, the unit educator presented the evidence at a staff meeting. The nurses listened politely and changed nothing. Several said privately that they would rather wake a patient than miss a deterioration, and that the new order would be "on the educator's license, not ours."
The problem is not a lack of information. It is that the practice is tied to experienced nurses' sense of what safe, responsible nursing looks like. This paper examines that problem through Mezirow's theory of transformative learning, explains why the theory fits adult learners whose assumptions are the barrier, and sets out a teaching plan grounded in it, with measures for whether learning and practice change.
Transformative Learning Theory
Mezirow (1997) described transformative learning as the process by which adults change their frames of reference, the structures of assumptions through which they understand experience. Frames of reference include habits of mind, broad ways of thinking shaped by culture and experience, and points of view, the specific beliefs and judgments that follow from them. Adults tend to reject ideas that do not fit their existing frames, which is why new information alone often has little effect. Transformation usually begins with a disorienting dilemma, an experience that the existing frame cannot explain, and proceeds through critical reflection on assumptions, discourse with others to test new interpretations, and action on the revised perspective.
Mezirow also emphasized that the educator's role is not to impose a new frame but to create conditions in which learners can examine their own assumptions: safe discussion, access to relevant evidence and experiences that expose the limits of the current view. The theory is especially suited to experienced professionals, whose expertise is both their greatest resource as learners and, at times, the source of their resistance.
Applying the Theory to the Night Shift
The nurses' frame of reference can be stated plainly: frequent vital signs protect patients, and a good night nurse checks everyone. That frame is rooted in real experiences, often a remembered patient who deteriorated overnight, and in a professional identity built around vigilance. The educator's staff meeting presented evidence that contradicted the frame without engaging it, so it was set aside. A teaching plan grounded in transformative learning would proceed differently.
The first step is a disorienting dilemma drawn from the nurses' own experience rather than from outside data. The educator could invite two or three patients recently discharged from the unit, with their consent, to describe what a night on the unit was like, or share anonymized comments from the hospital's patient experience surveys about being woken repeatedly. For nurses who see themselves as protecting patients, hearing that the routine exhausted and frightened those patients can create exactly the dissonance the theory describes.
The second step is critical reflection on assumptions. In small groups on the night shift, nurses would examine what the 2 a.m. vital signs actually detect in stable patients, what else signals deterioration, such as the patient's appearance, concerns from family or a change noticed during a routine check, and what is lost when a patient is woken. The educator asks questions rather than supplying answers, such as "When did a 2 a.m. set of vital signs last change what you did for a stable patient?"
Discourse, Evidence and Action
The third step is rational discourse, in which nurses test new interpretations against evidence and one another's experience. Here the educator introduces evidence, not as a verdict but as material for discussion. A quality improvement study in a children's hospital, for example, used electronic order changes and rounding checklists to reduce unnecessary overnight vital signs. Nights with one or fewer blood pressure measurements rose from 36% to 69%, with no increase in rapid response calls or intensive care transfers, although a composite measure of all vital signs improved at first and then returned to baseline (McDaniel et al., 2025). The study also found that white patients and patients whose language of care was English were more likely to be allowed uninterrupted sleep, a disparity that invites discussion of how nurses decide who is "stable enough." Presented this way, the evidence becomes something nurses reason about rather than something imposed on them.
The fourth step is action. Nurses co-design the unit's criteria for which patients may sleep without overnight vital signs, the safeguards, such as a quiet visual check and continuous pulse oximetry where appropriate, and a plan for reviewing any adverse events. Ownership of the criteria addresses the fear expressed in the staff meeting: the change becomes the unit's decision, backed by an order the physicians have agreed to, rather than someone else's policy.
Why a Different Theory Would Fall Short
Other learning theories are useful but less suited to this problem. A behaviorist approach, such as audits and feedback, might change what nurses do while the audits continue but would not change why they do it, and the practice would likely return when attention moved elsewhere, much as the composite measure in the pediatric study returned to baseline. A purely didactic approach assumes the problem is missing knowledge. Transformative learning addresses the underlying frame, which is what sustains the practice in the first place, although it takes more time and requires skilled facilitation. In practice, the educator may combine approaches, using transformative learning to change the frame and simple feedback to support the new habit. Matching the strategy to the learners and the problem in this way is among the competencies the profession expects of every nurse educator (Halstead, 2019).
Evaluation
Evaluation should look at both learning and practice. Short reflective statements written before and after the discussions can show whether nurses' reasoning about overnight monitoring changed. Practice measures include the proportion of eligible patients allowed to sleep without overnight vital signs, rapid response calls and intensive care transfers as balancing measures, and patient-reported sleep quality on the unit's experience survey. Because the pediatric study showed that gains can fade, measures should continue for at least six months, and the nurses who designed the criteria should review the results themselves.
Conclusion
Experienced nurses do not resist change because they lack information; they resist changes that conflict with assumptions built from years of practice and care for patients. Transformative learning theory explains that resistance and offers a path through it: a disorienting dilemma, critical reflection, discourse with evidence and colleagues, and action the learners own. For the night shift, that path is slower than a staff meeting but far more likely to produce a change that lasts, because it changes how the nurses understand their own vigilance rather than simply telling them to do less of it.
References
Halstead, J. A. (Ed.). (2019). NLN core competencies for nurse educators: A decade of influence. Wolters Kluwer.
McDaniel, L. M., Benjamin, H., Carlin, K., Desai, A. D., & Ralston, S. L. (2025). Improving sleep by minimizing unnecessary overnight vital signs in hospitalized patients. Hospital Pediatrics, 15(5), 387-397. https://doi.org/10.1542/hpeds.2024-008105
Mezirow, J. (1997). Transformative learning: Theory to practice. New Directions for Adult and Continuing Education, 1997(74), 5-12. https://doi.org/10.1002/ace.7401
How this N 582 Module 1 example is structured
Aspen does not publish N582 module prompts, so check your classroom for the exact instructions. This example opens with a failed attempt to change practice, explains transformative learning theory, applies each stage to the unit with specific activities, uses evidence as material for discourse, compares the theory with alternatives and closes with evaluation.
N582 Module 1 questions, answered
What does N582 Module 1 usually ask for?
Aspen's N582 description begins with principles of teaching and learning among diverse learners, so an opening paper applying a learning theory or principle to a real teaching situation is a typical first assignment. Check your classroom for the exact prompt.
What is a disorienting dilemma?
In Mezirow's theory, an experience that a learner's existing assumptions cannot explain, which prompts critical reflection and can lead to a changed perspective.
When is transformative learning the right approach?
When learners already have the relevant knowledge but hold assumptions or professional identities that keep them from acting on it, as often happens with experienced clinicians and long-standing practices.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.