DESIGNING EDUCATION

Learning Outcome:

I redesign learning environments based on Design-Based Education (DBE) principles by integrating authentic, collaborative, reflective, and student-centered learning activities that align with intended learning outcomes and foster students’ critical thinking, intercultural competence, and self-directed learning.

I taught and served as the coordinator of the subject Geriatric Care in Bali within the Healthy and Happy Aging Minor in 2024 and also the Health and Harmony Minor 2026. As a teacher and coach in this subject, my primary focus is on redesigning and enhancing the overall learning process for students. My objective is to establish a 20-week learning environment that inspires and motivates students to develop "Comparative Geriatric Care Practices: Learning from Bali/Indonesia and the Netherlands" to achieve one of the learning outcomes in this minor, namely "The student explores innovation through design thinking by developing customized solutions for Health & Harmony, beyond standard rules and regulations. By comparing Bali and the Netherlands in areas such as culture, health(care), prevention, technology, and well-being, the student identifies key insights. The outcome is an innovative approach addressing the question: What can Bali and the Netherlands learn from each other to create sustainable, future-proof health(care) and well-being solutions?"

Needs Analysis – Geriatric Care in Bali:

The redesign of the Geriatric Care in Bali course was initiated following a review of student feedback, learning evaluations, classroom observations, and reflective discussions. Although the course successfully introduced students to the cultural, social, and healthcare aspects of ageing in Bali, several opportunities for improvement were identified to enhance student engagement and learning outcomes.

Initially, learning activities were largely focused on lectures and information sharing about the lives of older adults in Bali, including traditional practices, community and hospital-based healthcare services, and nursing home care. While students gained valuable knowledge, observations indicated that some students remained passive during classroom sessions and relied heavily on lecturers as the primary source of information. Opportunities for students to actively explore, analyze, and reflect on the experiences of older adults were limited.

Furthermore, the course offered valuable field trips to community health services, nursing homes, and older adults' living environments. However, there was potential to maximize these authentic learning experiences through more structured collaborative activities, reflective assignments, and student-led discussions that would encourage critical thinking and self-directed learning.

Redesigned Geriatric Care in Bali Subject based on Design-Based Education (DBE):

Day et al. (2025) stated that there are 5 principles in DBE, namely Self-action Learning, Collaborative Learning, Contextual Learning, Constructive Learning, and Designerly Learning.

DBE Principle	Integration with Geriatric Care in Bali Topics
Self-Action Learning	Students actively investigate issues related to ageing in Bali and compare them with the Netherlands through group projects. Through topics such as Trend and Issues of Elderly in Bali, Ethical Aspects of Caring for Older People, and Problem-Based Learning: Ethical Aspects and Technology, students are encouraged to develop recommendations that contribute to improving elderly care and promoting the well-being of older adults.
Collaborative Learning	Students work in multicultural groups consisting of local and international students to complete comparative projects on nursing homes, community-based care, and complementary therapies. Learning occurs through discussion, peer feedback, group presentations, and shared reflection. Topics supporting this principle include Community-Based Geriatric Care in Bali, Institutional-Based Geriatric Care in Bali, and all comparative group assignments.
Contextual Learning	Learning takes place in authentic settings where students observe real-life elderly care practices. Through Visit Nursing Home (PSTW Wana Seraya) and Visit Posyandu, students connect theoretical concepts with actual healthcare delivery systems, cultural practices, and the lived experiences of older adults in Bali. Topics such as Elderly Living in Bali, Most Common Diseases in Balinese Older People, and Indonesian Health Care System and Elderly Care Policies further strengthen contextual understanding.
Constructive Learning	Students build new knowledge by integrating classroom learning, field observations, intercultural discussions, and reflection. Through topics such as Communicate with the Elderly, Psychosocial and Spiritual Issues in Balinese Older People, and Ethical Aspects of Caring for Older People, students critically reflect on their experiences and compare different perspectives from Indonesia and the Netherlands. Reflection activities help students construct deeper understanding and professional insights.
Designerly Learning	Students design innovative and evidence-based solutions to address challenges in elderly care. Through Problem-Based Learning: Ethical Aspects and Technology, Complementary Therapy for Elderly in Bali, and comparative projects, students analyze existing systems and propose improvements or innovative approaches for geriatric care. This process encourages creativity, critical thinking, and transformative problem-solving.

Redesign on the subject of Geriatric Care in Bali also adopts the Double Diamond Model, which outlines the four key stages of the design process: exploring the problem (Discover), defining the problem (Define), developing the solution (Developing), and delivering the solution (Deliver).

I'm trying to redesign the meeting based on the stages of the Double Diamond Model to make the learning process more structured and systematic. Previously on 2024, meeting topics within subjects hadn't been sequenced and considered according to this model.

Stage	Topic	Teaching Methods	Learning Activities & Outputs
Discover	Elderly Living in Bali: Cultural Aspects of Aging, Local Wisdom, and Society Trend and Issues of Elderly in Bali Communicate with the Elderly Most Common Psychosocial and Spiritual Issues in Balinese Older People	Interactive lectures, intercultural discussions, observation, interviews, literature review	Students explore the characteristics of ageing in Bali, identify cultural influences on elderly care, investigate current issues affecting older adults, and learn effective communication strategies.
	Visit Nursing Home (PSTW Wana Seraya)   Visit Posyandu	Field trip, observation, guided interviews, reflective notes	Students collect authentic data and observations about institutional and community-based elderly care services.
Define	Institutional-Based Geriatric Care in Bali Community-Based Geriatric Care in Bali Indonesian Health Care System and Elderly Care Policies	Group discussions, comparative analysis, problem identification, concept mapping	Students analyze findings from field visits and identify strengths, challenges, and opportunities within elderly care systems.
	Ethical Aspects of Caring for Older People Most Common Diseases in Balinese Older People: Physical Conditions	Case-based learning, ethical analysis, brainstorming	Students define key healthcare, ethical, and policy-related issues affecting older adults in Bali.
Develop	Complementary Therapy for Elderly in Bali Nursing Workforce, Education, and Professional Development in Indonesia	Collaborative learning, design thinking workshop, literature review, group project	Students develop potential solutions, recommendations, or comparative analyses regarding elderly care practices, workforce development, and complementary interventions.
	Comparative Group Assignment: Nursing Home and Health Care Systems in Bali/Indonesia vs. The Netherlands Community Health Care Systems in Bali/Indonesia vs. The Netherlands   Complementary Interventions in Bali/Indonesia vs. The Netherlands	Collaborative project, intercultural teamwork, peer learning	Students design and prepare comparative presentations and evidence-based recommendations.
Deliver	Problem-Based Learning Results: Ethical Aspects and Technology	Presentation, peer feedback, reflection, discussion	Students present proposed solutions and ethical analyses related to elderly care and healthcare technology.
	Final Comparative Project Presentation	Group presentation, peer assessment, self-reflection	Students communicate findings, justify recommendations, receive feedback, and reflect on intercultural and professional learning outcomes.

Implementation and Lecturer's Role in the Double Diamond Learning Design

Learning Arch of Health and Harmony Minor 2026

1. Discover Stage

Implementation
The Discover stage was designed to help students gain a broad understanding of ageing in Bali and explore the social, cultural, psychosocial, spiritual, and healthcare-related factors affecting older adults. Students were introduced to topics such as Elderly Living in Bali, Trend and Issues of Elderly in Bali, Communication with Older Adults, and common psychosocial and spiritual issues experienced by Balinese older people.

To deepen their understanding, students participated in field visits to a nursing home (PSTW Wana Seraya) and a community health service (Posyandu). Through observation, interviews, and interaction with older adults and healthcare providers, students gathered authentic information about the lived experiences of older people and the healthcare services available to them.

Lecturer's Role

As a lecturer, my role was to facilitate exploration and inquiry rather than simply provide information. I guided students in identifying relevant issues, encouraged critical observation, and supported them in collecting meaningful data during field visits. I also created opportunities for intercultural discussions between local and international students, helping them recognize similarities and differences in perspectives on ageing and elderly care.

2. Define Stage

Implementation
During the Define stage, students analyzed information gathered from literature, classroom discussions, and field observations. They explored topics such as institutional-based geriatric care, community-based geriatric care, Indonesian healthcare policies, ethical aspects of elderly care, and common physical health conditions among older adults.

Students worked collaboratively to identify key challenges, strengths, and opportunities within elderly care systems. Through case analyses and group discussions, they formulated problem statements and identified areas requiring improvement or further investigation.

Lecturer's Role
My role was to facilitate critical thinking and help students synthesize information from multiple sources. I guided students in analyzing evidence, questioning assumptions, and connecting observations with theoretical concepts. Through questioning techniques and structured discussions, I encouraged students to define meaningful issues that could be explored further in the next stage.

3. Develop Stage

Implementation
At the Develop stage, students generated ideas and developed evidence-based recommendations through collaborative and comparative learning activities. Topics such as complementary therapy for older adults and nursing workforce development provided opportunities for students to explore innovative approaches to elderly care.

Students worked in multicultural groups to compare healthcare systems, nursing home services, community-based care, and complementary interventions in Bali/Indonesia and the Netherlands. They developed presentations and recommendations based on literature, field observations, and intercultural discussions.

Lecturer's Role
As a facilitator, I encouraged creativity, collaboration, and evidence-informed decision-making. I supported students in exploring multiple perspectives, integrating theoretical and practical knowledge, and developing feasible recommendations. I also provided formative feedback throughout the process to help students refine their ideas and strengthen their analyses.

4. Deliver Stage

Implementation
In the Deliver stage, students presented the outcomes of their comparative projects and problem-based learning activities. They shared findings related to ethical issues, technology in elderly care, healthcare systems, and complementary interventions. Students justified their recommendations using evidence gathered throughout the course and reflected on their learning experiences. Peer feedback, group discussions, and self-reflection activities were incorporated to promote critical evaluation and continuous learning.

Lecturer's Role
My role was to facilitate knowledge sharing, reflection, and constructive feedback. I encouraged students to articulate their reasoning, defend their recommendations, and critically evaluate both their own work and that of their peers. I also guided reflective discussions to help students connect their learning experiences with future professional practice in geriatric nursing.

Reflection:

Reflecting on the redesign of the Geriatric Care in Bali course, I realized that previous iterations of the course in 2024 were primarily organized as a collection of individual topics without a clearly structured learning journey. Although the content was relevant and valuable, the sequence of learning activities did not explicitly guide students through a process of exploration, problem identification, idea development, and solution delivery.

Through the BDSQ course, I became more aware of the importance of educational design and the role of Design-Based Education in creating meaningful learning experiences. Consequently, I redesigned the course using the Double Diamond Model to provide a more systematic and student-centered learning process. The Discover stage enables students to explore the realities of ageing in Bali through cultural, psychosocial, healthcare, and community perspectives. The Define stage supports students in identifying key challenges and opportunities related to elderly care. During the Develop stage, students generate ideas and compare practices between Bali/Indonesia and the Netherlands, while the Deliver stage allows them to present evidence-based recommendations and innovative solutions.

This redesign aligns closely with the learning outcome of exploring innovation through design thinking. Rather than simply acquiring knowledge about geriatric care, students are guided to investigate authentic issues, compare different cultural and healthcare contexts, and develop insights that go beyond existing practices and regulations. By examining similarities and differences between Bali and the Netherlands in areas such as culture, healthcare systems, prevention, technology, and well-being, students are encouraged to think critically about how each context can learn from the other.

I observed that the redesigned structure created greater opportunities for collaborative learning, intercultural dialogue, reflection, and creative problem-solving. Students became more actively engaged in analyzing real-world issues and developing recommendations for sustainable and future-oriented health and well-being solutions. The comparative assignments and problem-based learning activities helped students move beyond descriptive learning toward innovation-oriented thinking.

As an educator, this experience shifted my perspective from organizing teaching around content delivery to designing a coherent learning journey that supports inquiry, reflection, and innovation. The Double Diamond framework provided a clear structure for aligning learning activities with intended learning outcomes and strengthened my ability to facilitate transformative learning experiences. Moving forward, I intend to continue refining the course design to further enhance students' capacity to develop innovative, culturally responsive, and sustainable solutions for future healthcare challenges.

References:
Li, Y. (2024). Foundation course design based on Double-Diamond model theory. In Proceedings of the 2024 International Conference on Financial Management, Humanities and Social Sciences (ICFMHSS 2024). Atlantis Press.

Day, I. N. Z., Assen, H. J. H. E., Stevens, T. M., & Vermunt, J. D. (2025). Practice what you preach: Lecturers learning about design-based education. Innovative Higher Education, 51, 387–405. https://doi.org/10.1007/s10755-025-09804-1.