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Creative Strategies for Teaching Millennial Nursing Students

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Do you ever lament that teaching nursing care has been reduced to lecturing about every disease known to humankind? Is your brain weary from not being able to motivate students so that you can have a lively, more engaged classroom? Are you tired of students complaining that they didn't pass board exams because you didn't cover something that was on NCLEX? If you aren't nodding your head yes, then perhaps you need a reality check in your classroom!

Today, there is such a variety of ways to engage students, to help them apply the knowledge they are gaining, and yes, be responsible and accountable for their learning. The use of interactive media, discussion boards, chat rooms, and games can help students realize that there are many active learning methods, and that having the instructor provide all of the information is not the best way. In fact, the latest research on learning demonstrates that students only retain 10% of what they hear, whereas they retain up to 75% of material that they have an opportunity to practice (Lalley & Miller, 2007). We know you have heard this a lot lately. Well, here are examples of how we have been able to do this in a way that is easy to execute and does not cause you to stay up all night thinking about what you are going to do with students for 2-3 hours of class.

Recently, we changed our curriculum, as well as our teaching strategies. The curriculum change drove us to select a way to teach that was unconventional for nursing schools. No longer did we provide an hour or two of Powerpoint slides and gloat over being the "talking heads." We don't cover fifteen diseases in two hours anymore. Instead, we began to incorporate activities that engaged the students, and required that they come to class prepared.

A key element of student preparation is completing the independent interactive learning modules provided by MyNursingLab . The four components of this online program are a diagnostic pre-test of six to ten questions, succinct review chunks of information, a few focused remember questions with rationales provided, two to three application questions from a case scenario, and finally a post-test that can be re-taken multiple times to help students retain the content.

The class time is usually shortened since students spend quite a bit of time completing MyNursingLab. Ideally, they have come to class prepared to be engaged in learning about the concept and the 2-3 concept exemplars. We use Kolb's cycle to organize our class time periods. We begin the class with a clinical story to "hook their interest." We have them reflect about what they already know about a patient with these exemplars in their small groups. Then we introduce key information through Powerpoint slides and limit their presentation time to 10-20 minutes. This encapsulates most of the general information that is critical for the student to know about a concept. The Powerpoint is very general or broad, but informative.

This is followed by a variety of activities that align with the objectives of the course and provide ways to keep the students interested. For example, it is hard for students to imagine how the asthmatic patient feels, unless they've experienced something like it. An activity that requires students to place a straw in their mouth and walk (or run) 30 feet and back quickly, then resume class (without taking the straw out of their mouth) serves as a very vivid reminder of how that asthmatic child or adult coming into the ER might feel. This exercise may trigger a different response from the nurse than a nurse who did not have this experience.

After the students have experienced "how it feels to have asthma," students present key facts about asthma, and then work through a simulation where the child or adult comes into the ER with an acute exacerbation of asthma. This activity can help them to tie the feeling of being smothered or not being able to breathe with the correct actions they must take as the nurse.

Another effective classroom strategy on this topic: show scenes in video format of how a family deals with having an asthmatic child, and have students outline a teaching plan for the family. Identify priorities in the teaching plan, and then have groups of students develop individual portions of that plan serve as a way to help them apply what they felt (through the straw activity), know (through readings, discussion, power point), and did (simulation) to a teaching situation.

Another example of an interactive strategy that we have used is to incorporate a neighborhood family (Pearson virtual community) into the class by having students develop a care plan for a family member who has had a hip replacement. This activity helps students apply the nursing process and develop nursing interventions.

In order to move your classroom from a group of non-engaged students, to a vibrant active learning environment where students are excited about learning, you must become comfortable with three things:

1) Require students to come to class prepared, or class will not happen until they are

2) Realize that it is not your fault that students do not learn content

3) Allow students who put forth the required effort prior to class to leave before the end of class.

If the objectives of the class are met in one hour because the students came prepared and they are comfortable with the content - let them out early - now isn't that a novel idea for nursing instructors?

Learn more about what we do in class to improve student achievement in our recently published educator study.

About the Authors

Suz Wilhelm, RN, PhD, is an assistant professor and assistant dean in the University of Nebraska Medical Center College of Nursing, West Nebraska Division, where she has been a faculty member since 1990. She received her bachelor's degree in nursing from the University of Northern Colorado and her master's and doctoral degrees from the University of Wyoming. Dr. Wilhelm's clinical background includes all areas of obstetrics. She has held nursing positions in several states in the mid-western region, and she conducts breastfeeding research in rural areas. Dr. Wilhelm has taught the under-graduate Maternal-Newborn and Women's Health course. She has taught in a concept based curriculum for the last 4 years. In addition, she has developed inter-disciplinary simulations for Maternity-Pediatrics. A strong advocate for concept-based learning, Dr. Wilhelm lent her considerable Maternity-Child Nursing and interdisciplinary expertise to ensure that the second edition of Nursing: A Concept-based Approach to Learning effectively threaded these themes throughout its content.

Dr. T. Kim Rodehorst is an associate professor at University of Nebraska Medical Center College of Nursing, West Nebraska Division, where she has been a faculty member since 1988. Kim received her bachelor's degree from Loretto Heights College in Denver, CO and her master's degree is in Parent-Child Health and from the University of Colorado. After working as a pediatric nursing instructor for many years, Kim returned to school to receive her Ph.D. in Adult Education and Technology from the University of Wyoming. Kim has developed numerous pediatric simulations over the past 20 years and often includes simulation learning in the classroom. Additionally, she has used a variety of innovative teaching strategies to engage students in their learning. Her interest in helping others learn more about concept based curricula began four years ago when UNMC adopted a concept based curriculum. Dr. Rodehorst has been involved in review and development of both editions of the textbook: Nursing: A Concept-based Approach to Learning.

Work Cited

Lalley, J.P. & Miller, R.H. (2007). The learning pyramid: Does it point teachers in the right direction? Education, 128 (1), 64-79.

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Susan Wilhelm, Assistant Professor and Assistant Dean, and Kim Rodehorst-Weber, Associate Professor, University of Nebraska Medical Center

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Active learning strategies for today's nursing students

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Do you ever lament that teaching nursing care has been reduced to lecturing about every disease known to humankind? Is your brain weary from not being able to motivate students so that you can have a lively, more engaged classroom?

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Background

Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies. This literature review identifies the teaching strategies for EBP knowledge and skills currently used in undergraduate nursing education. We also describe students' and educators' experiences with learning outcomes and barriers.

Methods

We conducted literature searches using Medline, Embase, CINAHL, ERIC and Academic Search Premier. Six qualitative studies and one mixed-method study met the inclusion criteria and were critically evaluated based on the Critical Appraisal Skills Programme. Using Braun and Clarke's six phases, the seven studies were deductively and thematically analysed to discover themes.

Results

Four teaching strategy themes were identified, including subthemes within each theme: i.e., interactive teaching strategies; interactive and clinical integrated teaching strategies; learning outcomes; and barriers. Although four studies included a vague focus on teaching EBP principles, they all included research utilisation and interactive teaching strategies. Reported learning outcomes included enhanced analytical and critical skills and using research to ensure patient safety. Barriers included challenging collaborations, limited awareness of EBP principles and poor information literacy skills.

Conclusion

Four of the seven analysed studies included a vague focus on the use of EBP teaching strategies. Interactive teaching strategies are used, but primary strategies focus on searching for and critically appraising research for practice-based application. Although this review included a relatively small sample of literature, the findings indicate a need for more qualitative research investigating interactive and clinically integrated teaching strategies towards further enhancing EBP undergraduate nursing students' knowledge and skills.

Teaching strategies

Evidence-based practice

Nursing education

Curriculum

Learning outcome

Interactive methods including interactive lectures, small group work, journal clubs, reading quizzes, clinical nurse presentations, workshops and problem-based learning are needed in teaching EBP [, ]. An interactive approach involves an interaction amongst the participants []. Effective learning reflects the quality of teaching. Learning though a constructivist approach refers to the creation of an environment in which the learner is an active participant who gains experience and engages in reflection, leading to problem-based, transformative learning [].To engage the next generation of nurses and enhance their EBP knowledge and skills, a variety of teaching strategies have been recommended [-].

Research supports the first level in this hierarchy when teaching EBP; i.e., an interactive style is often preferred because this method facilitates student learning [-]. Johnson et al. [] found that new learning methods and blended approaches to teaching EBP impact students' attitudes towards research. In addition, Crookes et al. [] identified different meaningful and engaging teaching strategies that have been adopted by nurse educators, such as online teaching, gaming and simulation techniques. However, these authors also concluded that nursing education needs to include more active lecture styles to strengthen the link between course content and clinical practice []. Ryan [] introduced teaching strategies as extrinsic factors and found that teaching EBP and research methods may be more relevant if taught in a clinical context rather than using traditional didactic methods.

The European Higher Education Area (EHEA) framework specifies expected learning outcomes for candidates with a Bachelor's degree, including skills in finding, evaluating, referring and applying scientific information []. Likewise, the Code of Ethics of the International Council of Nurses stresses that nurses must be aware of and implement research results into their clinical practice []. Despite these guidelines, it appears that teaching EBP in nursing education varies among nurse educators and universities, and that clinical preceptors may have insufficient knowledge needed to support students [, , ]. Recent research indicates that nurses may not be well prepared to use EBP in their clinical practice [, ].

There is a dearth of literature regarding the effect of teaching and learning strategies on implementing EBP in nursing education [, , , ] and it is currently unclear whether implementation of EBP training leads to improved nursing practice [].

Aim

In this literature review, we aimed to identify strategies for teaching EBP in undergraduate nursing education. The review questions were: "What teaching strategies are used to enhance knowledge and skills in EBP in undergraduate nursing education and what are the learning outcomes and barriers?"

Identification of studies

We conducted literature searches using Medline, Embase, CINAHL, Academic Search Premier and ERIC. The PICo framework for qualitative research was used to develop the review questions, plan the search and define the inclusion criteria. The population or participants assessed were nursing students, nursing education and nursing programmes. The phenomenon of interest was teaching and the specific context was EBP education. These concepts were transformed into the actual subject headings and text used in the search strategy in Medline (Table ), which represents how the concepts were truncated and combined using Boolean and proximity operators in all database searches. The search criteria included qualitative studies published in English from 2006 through 2017. This range was chosen based on an initial search in PubMed PubReMiner indicating that most research on EBP training in nursing education was published since 2006, when EBP gained a foothold in nursing education. We examined the references cited in the retrieved studies, as well as studies in Google Scholar that cited the retrieved studies.

The inclusion criteria were: 1) original, qualitative research focused on EBP teaching strategies in undergraduate nursing education, i.e., we focused on qualitative research to gain a deeper insight into teacher and student experiences with these strategies; 2) peer-reviewed, original research; 3) studies on educators, student participation, or both; and 4) studies evaluated as moderate or high quality according to the Critical Appraisal Skills Programme (CASP) []. The exclusion criteria were: reviews, quantitative studies, theoretical studies and contributions that were not original research articles. Articles related to teaching strategies directed at health-care personnel, master programmes or postgraduate nursing education were also excluded.

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) [] flowchart in the retrieval and selection process (Fig. ) to identify 972 records from an initial database search and an additional 35 by manually searching those studies' bibliographies. After duplicates were eliminated, we screened the abstracts of 724 articles. Of these, 708 articles did not meet our inclusion criteria, thus we obtained 16 full-text articles for further analysis. Each of the four authors examined all 16 articles, of which nine were excluded because of their low quality, focus on clinical intervention, or lack of focus on undergraduate nursing education. The final seven articles were included in the review.

Critical appraisal

All four authors independently appraised the seven final articles for their methodological quality using CASP (Table ), with moderate and high methodological quality defined as meeting 6-8 and 9-10 of the CASP checklist criteria, respectively. We discussed disagreements until consensus was reached.

Analysis

A thematic analysis was conducted to identify themes based on the six phases described by Braun and Clarke [], whose deductive approach refers to themes identified top down; in other words, we coded themes based on our specific review question. Although Braun and Clarke [] recommend using narrative text, the included qualitative studies and mixed-methods study provided text-based data. In the first phase, all four authors familiarised themselves with the research by reading and rereading the data from each study. In the second phase, the first author carried out a systematic, manual coding of features that led to initial codes, before searching for themes in the third phase. Phase four involved reviewing the themes for correlation with the codes and identification of subthemes. After defining the themes in phase five, the findings were evaluated for relevance to the research question. The authors met several times to discuss the analysis process and to reach consensus on the labelling.

A summary of the studies and their findings are presented in Table . The seven studies were conducted in Norway, the United Kingdom (UK), Sweden, Australia and Finland [-]. Qualitative data were also gathered from one mixed-methods study [] conducted in the UK which, although using mixed methods, reported qualitative findings from students' graffiti board comments and a focus group interview regarding lectures.

Implementation of changes to improve the teaching and learning of research methods in a second-year pre-registration nursing programme at one university.

Mixed methods

Teaching strategy: Established teaching modules related to the research process through student-centred approaches: e.g., experiential learning supported by the university's virtual learning platform. Teaching and learning approaches: teaching sessions, guided sessions, group work and presentation. Conducting a small research project in groups facilitated by a lecturer: conducting a literature review, developing a proposal, ethics, collecting and analysing data and presenting results. Outcome: research understanding, critical analysis and poster presentations. EBP and literacy as an integrated element throughout the whole curricula (faculty and library). Different dispositions towards learning. Important to develop good learning environments.

1. A questionnaire answered by 49 out of 53 nursing students.

2. An informal qualitative 'graffiti board' evaluation of the cohort.

3. Group interview with four lecturers.

Calculation of mean questionnaire scores and framework analysis.

Evaluation of students' and lecturers' experiences.

Examine the significance of a learning assignment in relation to research skills and nursing students' learning in clinical practice.

Qualitative: descriptive

Teaching strategy: Six-week programme in reading and oral presentations of results from a research article related to a chosen field and topic of nursing practice. Learning research skills created a better understanding of the format and core of an article in addition to introducing new perspectives. Oral presentation helped clarify research concepts, creativity was shown in presentations, increased awareness of research findings and clinical practice, academic presentation and discussion inspired the search for further research. The programme broadened students' understanding of nursing care and their future nursing role, nurses' responsibilities and evaluation of nursing outcomes.

Sample: 50 nursing students in clinical practice. Data collection: six open-ended questions related to research skills, learning during clinical practice and further development of the assignment. Content analysis.

Map development of IL skills among BN students.

Qualitative, exploratory and triangulated

The main themes were roles (of library, lectures and student peers) and collaborative strategies in the curriculum. Despite completing an IL course, students lacked a comprehensive understanding of IL and IL skills, while academics related the term 'IL' to general literacy and had varying levels of computer knowledge. Study outcomes indicated the need for staff development and a progressive approach to the curriculum to ensure that students understand IL and its links to life-long learning, which requires collaboration between librarians, study skills advisors and academics. There is a need for an orchestrated and progressive process to ensure development of students' IL skills, computer and information literacy, EBP and literacy as an integrated element throughout the whole curricula as well as cross-professional collaboration (faculty and library) in teaching.

Sample: focus group of 394 BN students and seven academics. Data collection: combination of document analysis, questionnaire and focus groups. Thematic analysis.

Evaluate BN students' and academics' understandings of IL, IL links to lifelong learning and subsequent implications for high-quality EBP.

The four themes (and subthemes within each theme) were: 1) Interactive teaching strategies (Research utilisation, Information literacy and Assignments as learning activities); 2) Interactive and clinically integrated teaching strategies (Teaching EBP principles and Clinical integration and collaborations); 3) Learning outcomes (Enhancing analytical skills and Changing attitudes toward utilising research); and 4) Barriers (Information literacy skills and knowledge and Challenging collaboration).

Interactive teaching strategies

An improved understanding of the differences between quantitative and qualitative methods was highlighted as an important aspect of preparation for nursing practice [-, ]. Interactive strategies to teach the research process, critical appraisal and development of information literacy skills were also emphasised. Interactive learning activities such as problem-based learning, sharing information, flipped classroom and virtual simulation, workshops, group work and seminars with discussions were identified [, , ]. In some studies, oral presentations of students' research findings in a clinical setting were highlighted as an important part of the teaching and learning strategy [, , ].

Research utilisation

Traditional teaching methods preparing students to use research were aimed at improving critical thinking skills, critically evaluating various literature sources and developing information literacy skills [-, ].

Experiential learning was often supplemented by collaborative group learning, such as partnerships for learning course content []. The authors presented experiential teaching approaches as a motivational tool for improving research learning. The students used student-centred approaches and completed small group research studies. Assignments included carrying out a literature review, developing a proposal, facing a mock ethics committee, and collecting and analysing data. This student work was supported by pertinent lectures, including via 'Blackboard', a virtual learning platform. Finally, students presented their methodologic and analytic approaches on the virtual learning platform [].

Information literacy

Teaching information literacy and interdisciplinary collaboration, especially with librarians, was emphasised as an important part of students' learning how to find and use research [-, -]. In contrast, collaboration with librarians was not mentioned in Mattila and Eriksson's [] study.

An environment supportive of the learning process promoted change and development. Collaboration with and facilitation and guidance by academic and library staff was considered essential for a successful process and outcome [, ]. It was also clear from these studies that nursing students need greater support to access, use and evaluate information fully [, , ].

Assignments as learning activities

Course assignments were included as a part of the learning process in all evaluated studies, which included activities preparing students to use research or enhance their EBP knowledge and skills. Assignments that were integrated into clinical practice were particularly emphasised in the studies that focused on teaching EBP principles [, , ].

An assignment focusing on analysis of health needs was undertaken to help student nurses gain an understanding of the relevance of EBP []. Nursing students were found to require further development of their critical appraisal skills and further improvement of the guidance from both academics and librarians was needed [].

Friberg and Lyckhage [] emphasised essay writing as a learning tool and used different literature-based research methods to meet this goal.

Interactive and clinically integrated teaching strategies

The thematic analysis identified interactive and clinically integrated teaching strategies. Interactive clinical strategies included assignments based on collaboration with health-care personnel in clinical practice. Learning activities with oral presentations of the findings from the students' studies delivered in their clinical work settings were also mentioned [, ].

Teaching EBP principles

Clinical integration and collaboration

In the study by Malik et al. [], students participated in clinical projects and analysed data with researchers. Clinical experts were also engaged in the lectures.

Cader et al. [] emphasised the benefit of students carrying out analyses of health needs through collaboration within the clinical practice context. To this end, nursing students conducted 'mini' research projects including an analysis of the health needs of a particular patient group with a common problem or diagnosis. Although the nursing students found the assignment challenging and time consuming, they also considered it meaningful because accessing information about health needs made the evidence relevant.

Mattila and Eriksson [] outlined a learning assignment conducted during a six-week clinical practice period in which students chose topics aimed at utilising research and enhancing their competence in the clinical practice context. The clinical instructor approved a selected research article that was applicable to clinical practice and the nursing students orally presented their findings to fellow students and staff at their clinical practice placement.

A Norwegian pilot study by André et al. [] focused on participation and cooperation in clinical research projects, which nursing students specified was a motivation for learning EBP. These students strongly appreciated working with experienced nurses on their clinical projects.

Learning outcomes

Students expressed that writing assignments helped them understand the research process. Based on the nursing students' reports, they were motivated by being able to choose topics that were of interest to them [, , ]. Learning outcomes from teaching strategies were presented in most of the studies we evaluated, and it was from these outcomes that the Enhancing analytical skills and Increased awareness of using research subthemes were identified.

Enhancing analytical skills

Based on the assignments they were given, the students in these studies reported learning outcomes such as understanding how to apply relevant evidence to everyday clinical practice. In this way, they learned to link research to health needs [-]. Mattila and Eriksson [] reported that nursing students gained greater insight into their future profession. That academic presentations and discussions inspired them to search for research was considered 'meaningful'.

Although nursing students considered themselves prepared to use research, Friberg and Lyckhage [] emphasised that students are insufficiently skilled to assess research critically. This perspective is consistent with the findings by Cader et al. [] that there is a need for further support for developing students' critical evaluation skills.

Some students emphasised the importance of bringing together clinical practice, their own practical experiences and the research context. They experienced EBP as a platform to facilitate the development of their curiosity and critical reflection within clinical practice [].

Changing attitudes toward utilising research

Barriers

Barriers to acquiring EBP and research utilisation skills were divided into two subthemes: i.e., information literacy skills and knowledge, and Challenging collaborations.

Information literacy skills and knowledge

Discontinuity of information literacy content throughout the curriculum seems to constitute a barrier to searching for and finding research []. In addition, some academics reported their own limited awareness of EBP teaching strategies [].

Challenging collaboration

The findings from this initial review demonstrate that various interactive teaching strategies have been emphasised to enhance knowledge and utilise research. However, despite being recommended strategies [, , ], factors such as teaching strategies that include clinical activities to develop EBP knowledge and skills seem to be given a lower priority. This review identified that self-reports and evaluations show that nursing students report development of critical thinking skills as a learning outcome of various teaching strategies [-, ], which is consistent with earlier studies [-]. In contrast, barriers to enhancing students' EBP knowledge and skills included a weak understanding of information literacy and difficulties finding and interpreting research.

Interactive teaching strategies

All analysed studies herein reported at least some use of interactive teaching strategies. Patient safety and quality of care in Western society require that future nurses have EBP knowledge, which means that they must use available research as well as patients' preferences and their own clinical expertise in decision-making processes [, ]. We identified studies that emphasised teaching strategies specifically aimed at finding research, critical appraisal and research utilisation through interactive methods [, , ]. However, it may be challenging for future nurses to obtain sound EBP knowledge if teaching strategies are mainly focused on research utilisation. A commission of health-care professionals and academic leaders presented their vision and common strategy toward strengthening global health-care systems, which argued that cross-professional collaboration in education is a powerful instrument for improving health-care outcomes []. Guiding principles, such as the code of ethics, the EHEA framework for expected learning outcomes [, ] and health legislation emphasise wider use of the best research evidence in nursing practice, which may explain why teaching strategies are primarily directed at research utilisation. Information literacy skills are important to EBP; however, studies show that nurses and nursing students lack these skills [, , -].

Clinically integrated teaching strategies

In the present review, three studies [, , ] focused on clinically integrated teaching strategies in particular. The relationships between the clinical practice context and health needs analysis [] were emphasised in a six-week clinical practice assignment, using oral presentation as a learning activity [] and participation in clinical research projects [].

Ryan [] identified that learning EBP would have greater relevance for students if teaching strategies took place in a clinical setting. According to Llasus et al. [], knowledge translation from education to clinical practice is challenging. These authors argue that if nursing students are expected to be able to implement EBP in clinical practice, they must have both EBP knowledge and EBP 'readiness', which requires strengthening their confidence in EBP.

Phillips and Cullen [] observed that development of EBP skills for RN-to-BSN students was influenced by exposure to educational partnerships, contextual teaching and learning, and clinical practice experience. However, the findings from a Norwegian study in physiotherapy students reported a lack of both EBP culture and role models in their clinical practice [].

A systematic review showed that EBP knowledge in medicine is increasing, irrespective of whether or not it is provided at undergraduate or postgraduate levels. Indeed, learning outcomes appear more effective if the teaching strategies are connected to clinical practice []. This notion was emphasised in the core clinical evaluation criteria developed in the Delphi Study by Bostwick and Linden []. In contrast, Ilic and Maloney [] found no difference in learning outcomes. Despite the variety of teaching strategies across the studies we reviewed, they cumulatively show good evidence that any form of teaching EBM increases knowledge.

The findings from this review demonstrate that collaboration through clinical practice and patient care appears to be a relatively low priority. Patients' preferences are not explicitly considered, despite an increased focus on seeing the patient as a collaborative partner in the EBP paradigm, ethical guidelines and legislation on education and health [, , , ]. This is also contrary to recommendations about the factors that influence EBP skills, such as contextual teaching and learning and practical experience opportunities [].

Becoming more analytical

It is worth mentioning that the nursing students in some of the studies included in this review increased their analytical skills because of EBP teaching strategies [-, ], regardless of whether the teaching focused exclusively on interactive or targeted both interactive and clinical strategies. However, research has shown that nursing students have inadequate knowledge to make them capable of judging, reflecting on and critically assessing research []. Becoming more analytical and changing attitudes towards utilising research in clinical situations may be essential for nurses in their future careers and could contribute to increased patient safety. These skills may lead to nurses with a higher level of analytical skills and clinical judgment, who have a greater ability to reflect and reason.

Course assignments as a teaching and learning strategy

According to the review findings, a variety of course assignments promote EBP knowledge and skills. Choosing topics of interest to students motivates them to develop EBP knowledge [, , ]. Several studies argue that assignments are essential for self-directed, continuous learning [, -].

Methodological limitations

There are some limitations to this review. We used a relatively small sample of articles and excluded non-English language studies, which may have caused us to overlook some studies on enhancing EBP skills and knowledge in nursing education. However, to ensure a systematic search process, the literature search was performed by AN, an academic librarian. In addition, our use of several databases likely decreased the possibility of selection bias. The six qualitative studies included in this study were homogeneous in terms of their qualitative research design and meeting our inclusion criteria. Qualitative data from the mixed-methods study that addressed our research question was also included. Variations such as cultural diversity and differences in participant perspectives may also have affected the analyses in these studies. Despite these limitations, we met our goal of examining teaching strategies, learning outcomes and barriers in undergraduate nursing education, from the perspectives of both educators and students.

Insufficient attention has been paid to the use of EBP principles in nursing education. The teaching strategies identified in the represented studies show that interactive teaching strategies are used alongside traditional lectures to enhance research utilisation skills in nursing education. However, collaboration with clinical practice to enhance EBP knowledge was only vaguely addressed in most of these studies. In conclusion, there is a need to improve educators' consciousness of and competences in teaching EBP principles, which involves using interactive and clinical integrated teaching strategies. Only seven studies met criteria for inclusion in this review, indicating that further targeted qualitative research is needed.

Acknowledgements

The authors acknowledge The University of South-Eastern Norway, Faculty of Health and Social Sciences for supporting this research.

Funding

The University of South-Eastern Norway, Faculty of Health and Social Sciences supported this research.

Availability of data and materials

Not applicable. All studies included in this review can be sourced online.

Authors' contributions

METH was the lead author who planned and implemented the study in close collaboration with AN, TF and ES. AN predominantly carried out the literature research. All authors collaborated on analyses. ES provided substantial support for the study as an expert in qualitative research. METH drafted the manuscript. All authors provided critical comments on the manuscript and have approved the final version.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

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Strategies for teaching evidence-based practice in nursing education: a thematic literature review

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Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies.

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Nursing students' viewpoints toward clinical conference

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Nursing students' viewpoints toward clinical conference

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Abstract

Keywords: Clinical conference, clinical education, clinical nursing round, students

Introduction

Recent changes in nursing performances have increased the requirement for nurses with high knowledge, managerial leadership skills, and power for committing to professional roles.[ 1] Therefore, the duty of planners and executors of nursing education for training more sufficient and empowered nurses is heavier than ever. Nursing education should provide appropriate context for the growth of critical thinking in students so that the students would be able to recognize nursing problems and present appropriate solutions for them. Hence, the students would be able to gain many opportunities for advancing and completing nursing skills within the appropriate educational context.[ 2] Creating opportunities require more serious investment in improvement of the clinical education quality. About 50% of nursing education courses are about clinical training.[ 3] Effective clinical training by increasing nursing students' learning, creating an opportunity for merging theoretical knowledge with clinical skills, development of clinical judgment skill, and gaining professional identity should prepare future nurses for having proper professional performance. Clinical environment is a dynamic environment which is filled with complicated variables for nursing students that could affect their learning.[ 4] Furthermore, clinical training is a dynamic process and a set of instructions and activities to facilitate learning in clinical environments which clinical instructors and students are involved in it equally.[ 5] The professor, students, and patients are the main three pillars if clinical training.[ 6] Used methods in clinical training should be in accordance with the goals, educational principles, individual differences in learning, interpersonal interactions, the capacity of the learner, available resources, and teacher's ability for effective and creative use of this method.[ 7] In other words, the training should be in a way to provide appropriate educational conditions and opportunities for entanglement and integration of theoretical and practical knowledge.[ 8] However, the employers mostly believe that nursing students do not have the required competencies for entering the labor market as a graduated nurse.[ 1] Various studies that have been conducted in Iran also have presented many challenges as the insufficiencies of clinical training including inappropriate physical environment, inappropriate mental atmosphere of the training environment, the duration of the training, and the number of the students.[ 9, 10] However, there are few studies conducted about the challenges of the methods of clinical training. Clinical round is one of the mostly used educational methods which would empower clinical reasoning and decision-making in students. Clinical conference, which means sharing experimental data in a group or asking students to represent a subject,[ 11] is one of the frequently used educational methods in clinical training of nursing students. Clinical rounds have been used as an appropriate solution for improving nursing training and performance in many situations.[ 12] The effectiveness of each of these two methods depends on the conformity of its execution stages with defined features of these methods. The present study was conducted to determine the level of conformity to the features of two methods of clinical conference and clinical rounds from nursing students' point of view.

Methods

This study was a descriptive-analytical study which was conducted to determine the level of conformity to the features of two methods of clinical conference and clinical rounds from the viewpoint of nursing students of Isfahan University of Medical Sciences in 2015. Students of the 4 th-6 th semester of nursing bachelor's degree were the study population for this research. Sampling was conducted through census method. The inclusion criteria were willingness to participate in the study, having passed at least two internship credits, and experiencing clinical round/clinical conference at least at one of the two internship credits. The 1 st semester students due to not having internship credits, the 2 nd semester students due to the nature of preliminary internship which is based on training practical skills, and the 7 th and 8 th semester students due to experiencing infield internship were not included in the study.

Data-gathering tool for this research was a researcher-made questionnaire which contained three parts of demographic characteristics (age, grade point average [GPA], semester, gender, marital status, and place of residence), clinical conference characteristics, and clinical round characteristics. The questionnaire for evaluating students' viewpoint of conformity to the characteristics of clinical conference included twenty items including three parts about evaluating students' viewpoints of planning for clinical conference, performing clinical conference, and satisfaction with clinical conference, respectively. The part of clinical round contained 25 items, respectively, about evaluating students' viewpoints of planning for clinical round, performing clinical round, and satisfaction with clinical round. Both parts of clinical conference and clinical round were scored with five-point Likert scale (always, mostly, sometimes, rarely, never).

The range of scoring for clinical conference and clinical round parts was from 0 to 100 that was divided into three equal groups of poor (0-33.3), medium (33.4-66.6), and good (66.7-100).

Content validity of the questionnaire was approved by sending it to ten nursing professors of the nursing and midwifery faculty of Isfahan University of Medical Sciences and modifying the items based on their recommendations. Reliability of the questionnaire was approved through pilot study. Fifteen nursing students completed the questionnaire and its validity was approved with a Cronbach's α of 0.78.

For gathering data, after taking necessary permissions from research council of the nursing and midwifery faculty and coordinating with the head of the education office of the faculty, the researcher coordinated with the professors who had classes with the 4 th-6 th semester nursing students and asked them to give a 15-min break to the students for filling the questionnaire (in the pilot study, the estimated time for filling the questionnaire was 10 min). After entering each class, the researcher explained the aims of the study for the students, and then, after taking verbal consent from the students and explaining the anonymity of the questionnaires and requesting them to answer the questionnaires independently, the questionnaires were distributed among the students. After gathering the data, it was analyzed using SPSS version 18 (IBM Company, Inc., Chicago, IL, USA), descriptive statistics (mean, standard deviation, and frequency distribution) and inferential statistics (independent t-test, ANOVA, Spearman correlation coefficient, and Pearson correlation coefficient).

Results

One hundred and thirty-four students participated in the study and the response rate was 82%. The age of the students was 21.9 ± 2.4 years and their mean of GPA was 15.95 ± 1.48 .

Table 1

Results of independent t-test showed a significant difference between the score of students' viewpoint of conformity to the features of clinical conference (34.89 ± 14.16) and clinical round (37.48 ± 15.97) ( P = 0.006, r = 2.78).

The viewpoints of 61 (45.5%), 71 (53%), and 2 (1.5%) of the students of conformity to the features of clinical conference were, respectively, poor, medium, and good. About conformity to the features of clinical round, 59 (44%), 69 (51.5%), and 6 (4.5%) students, respectively, had a poor, medium, and good viewpoint .

Table 2

The mean score of clinical conference in the field of planning was 34.65 ± 15.12, execution was 34.39 ± 17.21, and satisfaction with the method was 33.61 ± 15.3. For clinical round, the mean score of planning was 44.19 ± 22.22, execution was 37.72 ± 17.38, and satisfaction with the method was 33.19 ± 19.28 .

Table 3

Paired t-test showed a significant difference between the scores of students' viewpoint of clinical conference planning and clinical round planning ( P < 0.001, r = 4.8) and between the scores of execution of clinical conference and clinical round ( P = 0.006, r = 2.77).

Pearson correlation coefficient showed a significant relation between the scores of planning the method and execution of the method ( P < 0.001, r = 0.556), the scores of planning the method and satisfaction with the method ( P < 0.001, r = 0.651), and the scores of execution of the method and satisfaction with the method ( P < 0.001, r = 0.633) for clinical conference.

Pearson correlation coefficient showed a significant relation between the scores of planning the method and execution of the method ( P < 0.001, r = 0.622), the scores of planning the method and satisfaction with the method ( P < 0.001, r = 0.297), and the scores of execution of the method and satisfaction with the method ( P < 0.001, r = 0.295) for clinical round.

Pearson correlation coefficient showed no significant relation between students' age and GPA with their viewpoint of conformity to the features of clinical conference and clinical round ( P ≥ 0.05).

Independent t-test showed no significant difference between the scores of female and male students' viewpoint and also the scores of single and married students' viewpoint of conformity to the features of clinical conference and clinical round ( P = 0.05). However, this test showed a significant relation between students' gender and their viewpoint of conformity to the features of clinical round ( P = 0.04).

Spearman correlation coefficient showed a significant relation between students' semester and their viewpoint of conformity to the features of clinical conference ( P = 0.034, r = 0.18), but the relation between semester and clinical round was not significant ( P = 0.61, r = 0.04). Furthermore, one-way variance analysis revealed a significant relation between students' place of residence and their viewpoint of conformity to the features of clinical conference ( p 0.58) and clinical round ( P = 0.37).

Discussion

This study was conducted to evaluate the conformity to the features of clinical conference and clinical round from nursing students' viewpoint. Results showed weakness in conducting clinical conference and clinical round from students' viewpoint. In this regard, results of a study by Tod et al. which was aimed to find the facilitating factors of clinical evidence-based education showed that although clinical round has been recognized as an effective method for increasing students' empowerment, it is not conducted based on the standards.[ 13] Various reasons could justify this finding. Executing this educational method requires appropriate educational environment including a conference room in the ward or near the ward. Study of Mohebbi et al. (2012) revealed that one of the problems of clinical education was lack of a conference room in the wards (Mohebbi 2012). Abedini et al. (2009) also mentioned various factors such as the large number of students and lack of an appropriate educational environment as the problems of clinical education (Abedini 2009). Lack of experience of some of the clinical instructors could be another effective factor for lack of proper execution of clinical conference and round methods. Results of a study by Masoodi and Alhani (2007) showed that about 70% of the instructors with a working experience of <5 years believed that they did not have the required clinical skills and experiences for educating the students. Karimi et al. (2009) also believed that the most important obstacle for correct execution of clinical educational methods including clinical conference and round was lack of theoretical and practical knowledge of nursing professors in the field of clinical education. These researchers believed that occurrence unexpected events during the execution of clinical educational methods, especially clinical round, was another limiting factor of the mentioned clinical education methods.

Comparing the satisfaction with two methods of clinical conference and clinical round, students were more satisfied with clinical round than clinical conference. According to the results of Delaram, most of the students evaluated the aims and educational programs related to weekly conferences at an inappropriate level.[ 14, 15, 16, 17, 18]

Although results of the present study did not confirm any significant relation between students' semester and their viewpoint of conformity to the features of clinical round, the relation between students' semester and their viewpoint of conformity to the features of clinical conference was significant. In other words, students of higher semesters had more positive evolution of clinical conference. The reason could be due to the fact that students at clinical wards would more experience clinical conference than clinical round, and instructors mostly use the method of conference for clinical education of the students. Therefore, the possibility of mistake and error in clinical conference would be reduced compared to clinical round.

Conclusions

Clinical education is the heart of nursing education, and the most applicable clinical trainings depend on educational methods that could help students in gaining required clinical competencies. Based on the results of the present study about students' viewpoints, clinical training is facing serious challenges in the field of educational methods of clinical conference and clinical round. Since using these methods could be very helpful in clinical training of the students, it is necessary to conduct evaluations for determining the obstacles and providing operational guidelines for more appropriate execution of these methods.

Financial support and sponsorship

The present article was partially derived from a research project (no. 293314), approved by vice-chancellery for research in Isfahan University of Medical Sciences, Isfahan, Iran.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

The authors would like to thank the research chancellor of Isfahan University of Medical Sciences and the Education Development Office of the nursing and midwifery faculty of this university that made it possible to conduct this research. This article was adapted from the research project no. 293314 which was approved by the research council of Isfahan University of Medical Sciences, Isfahan, Iran.

References

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Nursing students' viewpoints toward two methods of clinical conference and clinical nursing round

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Keywords: Clinical conference, clinical education, clinical nursing round, students Recent changes in nursing performances have increased the requirement for nurses with high knowledge, managerial leadership skills, and power for committing to professional roles.[ 1] Therefore, the duty of planners and executors of nursing education for training more sufficient and empowered nurses is heavier than ever.

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Strategies for teaching Millennial students 

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Strategies for teaching Millennial students 

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Creative Strategies for Teaching Millennial Nursing Students

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Understanding How to Deliver Effective Nursing Education

As facilitators of nursing education, how can we best ensure that our learners are processing the new knowledge delivered to them through our educational programs? Designing sessions with this in mind should be a fundamental component of how we plan and facilitate education.

Xu (2016) suggests ten strategies to improve nurses' learning:

Strategy 1: Lecture

Despite being sometimes considered passive or boring, lecturing is believed to be a time-efficient, cost-efficient, effective way to present large amounts of new information to groups of learners. The ability to utilise different presentation techniques (e.g. slide-shows, videos etc.) can mean that students may find this approach to learning fun.

Strategy 2: High-Fidelity Simulation

Very realistic clinical scenarios help nurses to develop competence, teamwork, confident and critical thinking with minimal risk of harm to clients.

Strategy 3: Concept-Mapping

This learning strategy helps learners to note the ways that different ideas interlink. Concept maps can help students acknowledge their current understandings and form new ideas. Concept maps help learners to organise or process their knowledge logically.

It is suggested that this visual learning technique promotes critical thinking, analysis and evaluation. Learners also develop an understanding of their knowledge gaps and future learning needs.

Strategy 4: Online Courses

Online learning is helpful to nurses due to its flexibility, accessibility and cost-effectiveness. There is also a wide array of new and fresh content that can be found online.

Strategy 5: Games

Games in nursing education promote a positive, fun, engaging environment that increases motivation and interest of learners. Games can foster critical thinking skills and can be combines with other learning techniques such as lectures. Games can be played using various formats, even mobile apps.

Strategy 6: Role-Playing

Role-plays are not the same as simulations because they are not scripted and involve improvisation. Role-plays are important in nursing education as they facilitate the practice of communication and conflict management. It is important to debrief following role-playing to offer support and reflection, as well as further learning.

Strategy 7: Jigsaw Classroom

This technique involves making 'home groups' to complete tasks. A member is chosen to gather data and return the information to the home group. This strategy helps learners to increase their listening skills, engagement, and empathy. Again, it is imperative that there is an opportunity for thorough debriefing following the activity to ensure that support, reflection and increased learning can ensue.

Strategy 8: Case Study

Case studies are stories that are realistic and complex, that usually involve a conflict or issue that needs to be resolved by the learner. The aim is to close the gap between theory and practice, and improve action-planning and critical thinking. The educator needs to inform the learners of summarised suggestions to resolve the case study after the learners have had an opportunity to work on the case themselves.

Strategy 9: Debating

This approach facilitates critical thinking, alternative perspectives, and an opportunity to practice verbal communication and higher order of learning. This approach can help the learners develop research skills, and clear presentation of their ideas or arguments. Debriefing or discussion following the debate can help to provide learners with support, feedback, collaboration and critical thinking/evaluation.

Strategy 10: Problem-Based Learning

This approach involves giving learners an opportunity for learning through self-directed study, as well as teamwork. The educator may ask questions about a scenario and provide learners with feedback.

Learning is unique to the individuals's needs and is therefore not 'one size fits all' (American Psychological Association 2017).

As nurse educators, it is important that we recognise this and select appropriate teaching strategies in order to engage our learners, ensure that they effectively process the information that we are teaching them, and to deliver high-quality education.

References:

American Psychological Association 2017, Education psychology promotes teaching and learning, APA, Washington, DC, viewed 21 November 2017, http://www.apa.org/action/science/teaching-learning/index.aspx?tab=2

Xu, JH 2016, 'Toolbox of teaching strategies in nurse education', Chinese Nursing Research, vol. 3, iss. 2, pp. 54-57, viewed 21 November 2017, http://www.sciencedirect.com/science/article/pii/S2095771816300482

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10 Teaching Strategies to Improve Your Nursing Education | Ausmed

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As facilitators of nursing education, how can we best ensure that our learners are processing the new knowledge delivered to them through our educational programs? Designing sessions with this in mind should be a fundamental component of how we plan and facilitate education.

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Toolbox of teaching strategies in nurse education

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There are a variety of teaching strategies that instructors can use to improve student learning. It is of great importance to select appropriate teach...

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Clinical post-conference with a purpose video

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Clinical post-conference with a purpose video

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Faculty development - on your time, on your terms. online, onsite, conference.

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Below is a listing of the peer-reviewed teaching strategies published on our website. Each strategy submitted undergoes a blind peer-review by a volunteer QSEN Teaching Strategy reviewer. You will receive feedback on revisions from the reviewer and then submit your revisions. You can scroll through the listing or search the strategies by author, title, and keywords.

QSEN Teaching Strategies Director

Yolanda Nelson, EdD, MSNed, RN-BC, (December 2018 - present) nelsony1@tcnj.edu

QSEN Practice Strategies Director

Bethany Robertson, DNP, CNM, (December 2018 - present) robertsonbethany66@gmail.com

Nell Hodgson Woodruff School of Nursing

QSEN Teaching Strategies Coordinators

Fay Alexander (May 2017 - present) fxa31@case.edu

Dorothy Nurzynski (December 2018 - present) dbn7@case.edu

The materials on the QSEN Web site are freely available for educational use, but original content such as the teaching strategies must be cited. Please read our Terms and Conditions before using this material.

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Below is a listing of the peer-reviewed teaching strategies published on our website. Each strategy submitted undergoes a blind peer-review by a volunteer QSEN Teaching Strategy reviewer. You will receive feedback on revisions from the reviewer and then submit your revisions. You can scroll through the listing or search the strategies by author, title, and keywords.

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Transitioning from clinical nurse to nurse faculty

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Transitioning from clinical nurse to nurse faculty

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This tool kit was prepared by Hilda Haynes-Lewis, Jonas Veteran Healthcare Scholar (2014-2016) and Triniece Pearson, Jonas Nurse Leader Scholar (2014-2016) for the Graduate Nursing Student Academy (GNSA). AACN has not officially endorsed the materials contained therein.

Overview

The nursing shortage has fueled increased demand for nursing faculty. The average age of nursing faculty is increasing and many are expected to retire in the next decade. The demand to educate new nurses has led nursing schools to look for new solutions that solve the nursing faculty shortage. These solutions include developing new faculty roles that ease the transition from the bedside to academia. Since nursing faculty are on the forefront of creating the next generation of registered and advance practice nurses, increasing the number of nursing faculty, especially those of diverse ethnic backgrounds is also imperative to the advancement of the field.

Nurses are an integral part of the healthcare team. Changing from clinical to academic life and balancing both can cause role strain. Role strain stems from a conflict between the familiar expectations in your current role as a clinician and the new demands of an academic position. Taking time to thoroughly consider the transition to academia is the first step. This tool kit and webinar are here to inform and serve as a starting point when considering a faculty role. A guide to mapping out the transition and the responsibilities of desired faculty roles are discussed.

The purpose of this tool kit is to:

Explore the concept of role change and the impact of role change, from clinician to faculty, on the individual.

To provide a theoretical framework for transitioning into a faculty role as described in the literature.

To describe the faculty positions available for the clinician and provide a roadmap for attaining that position.

Note: The resources of this tool kit are not exhaustive. This document is a starting point of articles that inform the transition to nursing faculty.

The definition of role change or role transition has been described in the literature as any transition from one set of behaviors to another. According to Melesis (2010) role transition involves the need to attain new knowledge, changes in social status and interactions with others that may lead to feeling of instability and uncertainty since self-identity and role change can occurs simultaneously as you move from novice to master in the newly defined role.

Role theory posits that people learn to adapt to the roles given to them by society and the rules that are agreed upon by society for a given role. The roles that individuals have are learned behaviors (Goodling, 2003). Similarly Transition Theory states that people can learn and adapt to changes. Transitions theory notes that change happens over times therefore the experience of transition is fluid.
Suggested References
Anderson, J. K. (2009). The work-role transition of expert clinician to novice academic educator. The Journal of Nursing Education, 48(4), 203-208. doi:10.3928/01484834-20090401-02

Clark, N. J., Alcala-Van Houten, L., & Perea-Ryan, M. (2010). Transitioning From Clinical Practice to Academia. Nurse Educator, 35(3), 105-109. doi:10.1097/NNE.0b013e3181d95069

Goodling, S. M. (2003). Transition from academia to home health practice. Home Health Care Management & Practice, 16(1), 17-24. doi: 10.1177/1084822303260198

Meleis, A. I. (2010). Transitions theory: Middle-Range and situation-Specific theories in nursing research and practice. New York, EUA: Springer publishing company.

Ramsburg, L., & Childress, R. (2012). An initial investigation of the applicability of the
Dreyfus skill acquisition model to the professional development of nurse educators. Nursing education perspectives, 33(5), 312-316. doi.org/10.5480/1536-5026-33.5.312

Schoening, A. M. (2013). From bedside to classroom: The nurse educator transition model. Nursing education perspectives, 34(3), 167-172. doi.org/10.5480/1536-5026-34.3.167

The transition from the role of nurse clinician to that of faculty and a member of the academic society can result in internal conflict and cognitive dissonance since the expectations as a clinician and the multitude of demands of an academic position. Clarke et al (2010) states that this incongruence can result in role stress which has four causes; ambiguity, incongruity, conflict and overload, which are below.

Ambiguity

Ambiguity occurs when there is a deficiency of clarity surrounding the behaviors and responsibilities associated with the role are not well defined or understood by the parties involved; the clinician, the medical institution or the academic institution.

Ambiguity is a common occurrence because most clinicians have not been socialized into the culture of academe.

Incongruity

Incongruity is the incompatibility between the different aspects contained in the role. There can be conflict between the skills and abilities, values and expectations or role obligations.

Conflict

Role conflict arises when the expectations are perceived to be contradictory or incongruent and can result in irreconcilable demands on the part of the nurse or the institution.

Overload

Overload occurs when the demands of the roles or roles overwhelm the new faculty member resulting in difficulty in meeting the obligations of the role in the prescribed time.

Overload can lead to workplace tension, anxiety, and personal conflict that can result in the exhibition of negative behaviors.

Components of a Smooth Transition

Become immersed in academic culture by reading journals on nursing education in addition to clinical journals.

Suggested References

Anibas, M., Brenner, G. H., & Zorn, C. R. (2009). Experiences described by novice
teaching academic staff in baccalaureate nursing education: A focus on mentoring. Journal of Professional Nursing, 25(4), 211-217. doi.org/10.1016/j.profnurs.2009.01.008

Clark, C. L. (2013). A mixed-method study on the socialization process in clinical
nursing faculty. Nursing education perspectives, 34(2), 106-110. doi.org/10.5480/1536-5026-34.2.106

Clark, N. J., Alcala-Van Houten, L., & Perea-Ryan, M. (2010). Transitioning from
clinical practice to academia: University expectations on the tenure track. Nurse Educator, 35(3), 105-109.doi: 10.1097/NNE.0b013e3181d95069

Duffy, R. (2013). Nurse to educator? Academic roles and the formation of personal
academic identities. Nurse education today, 33(6), 620-624. doi.org/10.1016/j.nedt.2012.07.020

Gazza, E. A. (2009). The experience of being a full-time nursing faculty member in a
baccalaureate nursing education program. Journal of Professional Nursing, 25(4), 218-226. doi:10.1016/j.profnurs.2009.01.006

McDonald, P. J. (2010). Transitioning from clinical practice to nursing faculty: Lessons
learned. Journal of Nursing Education, 49(3), 126. doi:10.3928/01484834-20091022-02
Penn, B. K., Wilson, L. D., & Rosseter, R. (2008). Transitioning from nursing practice to
a teaching role. Online journal of Issues in Nursing, 13(3).
doi:10.3912/OJIN.Vol13No03Man03

Roberts, S. J., & Glod, C. (2013, April). Faculty roles: Dilemmas for the future of nursing
education. In Nursing forum (Vol. 48, No. 2, pp. 99-105).doi: 10.1111/nuf.12018

Schaar, G. L., Titzer, J. L., & Beckham, R. (2015). Onboarding New Adjunct Clinical
Nursing Faculty Using a Quality and Safety Education for Nurses-Based Orientation Model. Journal of Nursing Education, 54(2), 111-115. doi:10.3928/01484834-20150120-02

Weidman, N. A. (2013). The lived experience of the transition of the clinical nurse expert
to the novice nurse educator. Teaching and Learning in Nursing,8(3), 102-109. doi:10.1016/j.teln.2013.04.006

Ziehm, S., & Fontaine, D. K. (2009). Clinical faculty: tips for joining the ranks. AACN
advanced critical care, 20(1), 71-81. doi: 10.1097/NCI.0b013e31819453ab

Bednash, G., Breslin, E. T., Kirschling, J. M., & Rosseter, R. J. (2014). PhD or DNP: Planning for Doctoral Nursing Education. Nursing Science Quarterly, 27(4), 296-301. doi:10.1177/0894318414546415

Sonson, S. L. (2013). DNP-prepared APRNs: Leading the magnet?? charge. Nursing Management, 44(7), 49-52. doi:10.1097/01.NUMA.0000431425.39076.81

What Is Tenure?
A guaranteed job contract given to academic professionals that have shown skills over a period of time. It provides security from being laid off without sufficient justification. Primary responsibilities include: teaching and research, independent program of research, publications,teaching undergrad and/or graduate students, serving as an academic/research advisor of students involvement.

Tenured Positions

Tenured Professor
After all other promotions have been reached

Associate Professor
On-Track to be a Full Professor upon evaluation of requirements needed for promotion. These requirements may vary by University/department.

Assistant Professor
Entry level tenure-track position for PhD graduates. DNP graduates may also be eligible for entry-level tenure-track positions depending on the University. On-Track to be an Associate Professor upon evaluation of requirements needed for promotion. These requirements may vary by University/department.

Non-tenured Positions

Adjunct Faculty
Non-tenure/part-time/per course. Primary duty is teaching. This includes developing syllabi, coordinating curriculum, facilitating class instruction, evaluating student performance, holding office hours, maintaining course website (blackboard).

Bachelors Degree (Required)

Master's Degree or DNP (May be required if teaching at graduate level

Nursing Experience (Active RN License

Clinical Instructor
Primary role is supervising students during clinical rotations. Coordinating with clinicians at clinical sites, making student assignments, instructing students on how to perform duties in the clinical site, evaluate students' work.

Active RN License

2+ years of clinical experience

BSN (MSN or DNP Preferred)

Research Faculty
Sustain a program of research that provides their salary. Publish in peer-reviewed clinical journals, present research findings at conferences, advise students in research activities. Serve on thesis and dissertation committees. Teaching expectations are limited.

Suggested Resources:

Faculty Roles

Duffy, R. (2013). Nurse to educator? Academic roles and the formation of personal academic identities. Nurse Education Today, 33(6), 620-624. doi:10.1016/j.nedt.2012.07.020

Roberts, S. J., & Glod, C. (2013). Faculty roles: Dilemmas for the future of nursing education. Nursing Forum, 48(2), 99-105. doi:10.1111/nuf.12018

Tenure

Gaugler, J. E. (2004). on the Tenure Track in Gerontology: I Wish I Had Known Then What I Know Now. Educational Gerontology, 30(6), 517-536. doi:10.1080/03601270490445122

Singh, M. D. (2015, July). An Exploration of the Pre-Tenure and Tenure Process Experiences of Nursing Faculty. In Sigma Theta Tau International's 26th International Nursing Research Congress. STTI

Smeltzer, S. C., Sharts-Hopko, N. C., Cantrell, M. A., Heverly, M. A., Wise, N. J., Jenkinson, A., & Nthenge, S. (2014). Challenges to research productivity of doctoral program nursing faculty. Nursing Outlook, 62(4), 268-274.

Sussman, S. M. (2012). Job satisfaction and support for transitions in the nursing academy: A qualitative study of tenured nursing faculty who stay in academia (Doctoral dissertation, Teachers College, Columbia University).

Non-Tenure

Paul, P. A. (2015). Transition from novice adjunct to experienced associate degree nurse educator: A comparative qualitative approach. Teaching and Learning in Nursing, 10(1), 3-11.

Nicholes, R. H., & Dyer, J. (2012). Is eligibility for tenure possible for the doctor of nursing practice-prepared faculty?. Journal of Professional Nursing, 28(1), 13-17.

Schaar, G. L., Titzer, J. L., & Beckham, R. (2015). Onboarding New Adjunct Clinical Nursing Faculty Using a Quality and Safety Education for Nurses-Based Orientation Model. Journal of Nursing Education, 54(2), 111-115. doi:10.3928/01484834-20150120-02

Website Resources:
AACN Career Center
AACN's online resource dedicated to employment opportunities in nursing education.

HigherEd Jobs Listing of faculty positions (on-site or remote)

Education Nurses.com
Provides nursing education modules for new educators

Graduate Nursing Student Academy Career Network
Job board developed through partnership between AACN and AfterCollege.

National Council of State Board of Nursing - Nurse Licensure Compact
To determine if you live in a state included in the Nurse Licensure Compact

Professional Organizations to Consider:
It is important to maintain membership in professional associations that are tied to your area of specialization or instruction.
Association of Black Nursing Faculty National Association of Ethnic Minority Nurse Associations National Organization of Nurse Practitioner Faculties Professional Nurse Educators Group Sigma Theta Tau International The International Society of Nursing

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Transitioning from Clinical Nursing to Nursing Faculty

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The American Association of Colleges of Nursing (AACN) is the national voice for baccalaureate and graduate nursing education. AACN works to establish quality standards for nursing education; assists schools in implementing those standards; influences the nursing profession to improve health care; and promotes public support for professional nursing education, research, and practice.

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Background

As a clinical skills educator I am involved in the delivery of simulation based education for UK trained doctors in their first year post qualifying (Foundation Year 1 [FY1]). I have an interest in the use of feedback and debrief as a tool to improve performance through reflection.

When relating simulation to Kolb's learning cycle it is evident that taking part in the simulated scenario only accounts for the concrete experience component. Debrief and feedback accounts for the reflective observation, abstract conceptualization and active experimentation components of the learning cycle by helping participants make sense of the simulation scenario and reflect on their practice to improve future performance.

Preparation for simulation

A simulation event took place in a hospital skills laboratory set up to resemble a patient bed space. All simulation scenarios involved the management of an acutely unwell patient. Each participant was an FY1 doctor and all participated in a simulation scenario followed by feedback from both faculty and the other participants attending the event.

Four participants attended the event in total. This small group size allowed for debate and discussion as well as helping students to feel relaxed and promoting interaction between the participants. All participants had completed their training in the UK so it was assumed they already had a threshold of knowledge and skills as documented by the General Medical Council (GMC).

Prior to the simulation event individualized scenarios were developed relevant to each participant's current placement as it is important for the simulation to be appropriate for students' needs., It could be argued that by only focusing on what it is felt students "need to know" they are not experiencing a full breadth of learning. However, I consider that the scenarios delivered to the students are common emergency scenarios that could potentially be experienced across all disciplines of medicine.

Learning outcomes that fulfilled the requirements of the GMC, were usedas a basis for developing the simulations. Clear outcomes were set for the event so participants knew what knowledge; skills, attitudes and behaviours needed to be demonstrated., The outcomes included both the technical and non-technical aspects of care delivery. Both of these aspects are imperative in delivering safe patient care ⁻ and are focused on critical thinking and problem solving. Discussing the learning outcomes at the beginning of the event enabled exploration of the importance of non-technical skills. In the future, I plan to ask the students what their objectives for the session are to increase participation, motivation and performance. The HEA recognizes that student centred learning increases student confidence and excitement about the subject.

Delivering the simulation

On the day of the simulation, students were given an overview of each of the faculty members' roles and information regarding the manikin's limitations and equipment being used. Identifying limitations before starting the scenarios improved fidelity as the faculty didn't have to interrupt the scenario to acknowledge constraints.

Providing a pre-brief at the beginning of the session was useful and helped to facilitate reflective practice by preparing students for the discussion at the end of their scenario and making them aware of how they would receive their feedback. It also alerted the students that they were equal partners in the feedback process and triggered internal feedback.,

Each student was allocated a scenario and acted as the team leader whilst faculty acted as other members of the healthcare team. During the scenario the faculty observed the students' so that feedback could be given. However,direct observation does not facilitate in-depth exploration of clinical reasoning or problem-solving abilities. In future sessions a member of the faculty will act as a medical student to question the participant and determine their underpinning knowledge.

Debrief and feedback

After completing the individual scenarios, oral feedback was given to students by the faculty and their peers. Group feedback and peer learning are all effective assessment for learning tools. Individuals can learn a lot through the experience alone but specific feedback will maximise learning.,

Waiting until completion of the scenario before giving feedback allowed the participants to self-reflect and make sense of what had just happened. Facilitators and peers were then able to discuss the strengths and weaknesses of the student's performance without interrupting the scenario and decreasing scenario fidelity and allows participants to discuss the consequences of their actions.

Feedback on the participant's performance is the most important feature of simulation education as it produces long lasting learning and allows the student to develop a deep insight and reflection about their performance as well as slowing the decay in knowledge.

During debrief students discussed any emotions that they had about the simulation scenario as well as reflecting on and exploring their decision making processes. Giving oral feedback to students enabled the faculty to be flexible with their questioning, allowed an immediate response from the student and permitted clarification of any misunderstandings. However, oral feedback does not allow the person giving feedback time to reflect on the student's performance.

A criticism from one of the participants was that they would have liked written feedback for portfolio evidence. One option would be for the faculty to meet after the event, discuss each student's performance and then email individual feedback. However, this option would be time consuming and may not be feasible.

When giving feedback, the first question the student was asked was: "How do you feel that went?" This facilitated self-evaluation which is essential to reducing the emotive impact of feedback. Facilitating self-evaluation will also promote the student to function in a reflective mode in their daily practice. However, we all hold biases in the way we judge our own performance. Self-evaluation relies on the student to be self-aware and effective at critiquing their own performance; a skill not always present. Self-evaluation alone is inadequate for performance improvement, it needs to be facilitated by skilled evaluators who can change their questioning strategy appropriately to ensure student understanding.

Overall participants evaluated the simulation event as a valuable learning experience that gave them a chance to apply their theoretical knowledge to simulated reality and made them aware of the national and local guidance available to them. However, feedback was identified as an area for faculty development. One student asked for "more strict feedback" This feedback itself is somewhat unhelpful due to its vagueness. Another student asked that the "feedback sandwich" be "more strictly enforced". I have never been a devotee to the feedback sandwich as I find it predictable, patronising and a wasted opportunity to discuss the meat of the issue and improve student performance. For feedback to be useful it needs to lead to action which will improve the student's performance.,,, Feedback can only do this if it identifies specific areas for development and supports the learner in identifying strategies to bridge the gap between current and desired performance.,

The simulation event presented valuable learning for the faculty. Most student errors were human factor errors. For example, guidelines were either not used or not followed correctly and communication was often poor leading to delays in patient treatment. In future sessions more emphasis will be put on human factor training and a structured model of debrief will be used.

Conflict of Interest

The author declares that she has no conflict of interest.

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Using debriefing and feedback in simulation to improve participant performance: an educator's perspective

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As a clinical skills educator I am involved in the delivery of simulation based education for UK trained doctors in their first year post qualifying (Foundation Year 1 [FY1]). I have an interest in the use of feedback and debrief as a tool to improve performance through reflection.

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5 ways to get nursing students engaged in your classroom

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5 ways to get nursing students engaged in your classroom

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5 Ways to Get Nursing Students Engaged in Your Classroom

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Reach that "holy grail" of teaching by utilizing these concept-based strategies for engaging students in learning in your nursing program.

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Student Facilitation of Simulation Debrief: Measuring Reflective Thinking and Self-Efficacy

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Student Facilitation of Simulation Debrief: Measuring Reflective Thinking and Self-Efficacy

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Fundamentals of Nursing Co-Author Barbara L. Yoost, MSN, RN, CNS, CNE, ANEF shares ten ideas for infusing active learning into your classroom lessons.

1. Patient Teaching Pamphlets
Create a sample patient that has an illness or injury related to what you're currently covering in class. Then ask each student to develop an educational pamphlet, flyer, or mini brochure for that patient. Make sure students cover all the necessary information in their pamphlet such as: risk factors, signs and symptoms, when to call the primary care provider, treatments, prevention strategies, and online and community resources for further information. Encourage students to be creative with the design and writing of the piece to make the information engaging and understandable for the patient.

2. Ace® Wrap Relays
Divide the class into teams (2-4 teams depending on size of classroom and number of available patient mannequins or body parts). In the relay, each member of a team takes a turn at wrapping and unwrapping a specific body part of a "patient". The actual ace bandage serves as the baton as it is handed from one team member to the next. The team that finishes all of their wrappings effectively in the fastest amount of time wins. You may decide to have each student complete their bandage wrapping on the same body part for the same problem (e.g. every student performs a wrap on an amputation below the knee), or you can vary the body parts, problems, and wrap style depending on the relay round (e.g. student 1 from each team does a figure 8 wrap on a right leg with edema, student 2 does a spiral wrap on a sprained left ankle, and so on). For an extra challenge, have each student assess the wrapped extremity for circulation, sensation, and movement. You can even have students document their care electronically before moving on.

3. NCLEX Exam Authors
Break students into pairs and have them write ten different NCLEX exam-style questions on a specific nursing concept or class topic. Make sure students include a variety of wrong responses along with the correct answer. Then have students present their questions and response options. After classmates vote on which answer is correct, have the presenting pair reveal the correct answer and explain their rationales for both the right and wrong responses.

4. O2 Bingo
Introduce your class to O2 Bingo by creating bingo boards with oxygenation terms (think oximetry, CPAP, hypoxia, etc.). Then ask students questions and have them mark the answer on their boards. The bingo game can also be developed to cover a variety of different nursing concepts and related exemplars. For a creative end-of-the-year review idea, have each of your students develop their own bingo cards and questions surrounding a specific nursing concept. Then have the entire class play a round of bingo to review the concept.

5. Medication Commercials
Divide students into groups of two or three and have them write and perform medication commercials. You can have the entire class cover the same medication or have each group cover something different. After each group performs their commercial, have the class compare and discuss what they experience in the clinical area versus what they read about in research.

6. Unfolding Case Studies
Bring the subject to the center of your classroom by incorporating unfolding case studies into your lesson. Start off by providing basic assessment data on a patient. As class progresses, continue to reveal more information about that patient and their disease/disorder. Make sure students have their smartphones, tablets or laptops on hand to reference medication, diagnostic testing, and care planning point-of-care software.

7. Reading Reflections
Assign a particular section of the text to read for homework. Then at the beginning of the next class, have students write down: 1.) three things they learned from the reading, 2.) one way that learning might affect them in clinical practice, and 3.) one question they hope to have answered today in class. Have students hand in their written reflections, and then discuss the various takeaways as a class. Ask students to help answer their classmates' questions from the reading. This short exercise is a great way to ensure students complete the assigned reading ahead of time.

8. The Sensory Deprivation Experience
When covering nursing concepts such as functional ability or sensory perception, have students take turns experiencing the blind or deaf patient's point of view during simulation or a classroom activity by having the student wear a blindfold or earplugs respectively. Afterwards, have students discuss what they felt and learned from their sensory deprivation.

9. Name That Personal Care Item
Use this identification game to familiarize fundamentals students with the patient care items they will frequently encounter on the job. Start by collecting a variety of personal care items, such as a fracture pan, regular bed pan, catheter, etc., and set them on a table. Give each item a number and hold them up one item at a time. Then have students write down what they think the item is. This game can be used in place of a quiz where students individually write down the answers on a piece of paper to hand in. Or for an interactive review, divide the class into four teams and carry out the activity as if it were a round in a game show (first team to ring the bell gets to guess, and so on).

10. Clinical to Classroom
Each week, assign one student to write a case study based anonymously on a former clinical patient whose diagnoses relate to concepts being covered in readings and class. Have the student present his/her case study. Then allow classmates time to discuss their possible answers to the questions provided in the case study. Finally, have the author lead a discussion about the clinical patient case study and provide the "correct answers" that the authoring student prepared from required class readings, preparatory research, and his/her actual clinical experience with the patient. These can be submitted to you prior to class for review and you can then post it on the course website for all students to download prior to class.

For more resources on active learning and flipping your classroom click here.

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10 Active Learning Exercises to Engage Students | Elsevier Evolve

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Fundamentals of Nursing Co-Author Barbara L. Yoost, MSN, RN, CNS, CNE, ANEF shares ten ideas for infusing active learning into your classroom lessons. Patient Teaching Pamphlets Create a sample patient that has an illness or injury related to what you're currently covering in class.