What does an innovative teaching assignment strategy: mean to nursing students?
Article Type:
Nursing students (Beliefs, opinions and attitudes)
Nursing education (Innovations)
Nursing education (Methods)
Neuman, Lois H.
Pardue, Karen T.
Grady, Janet L.
Gray, Mary Tod
Hobbins, Bonnie
Edelstein, Jan
Herrman, Judith W.
Pub Date:
Name: Nursing Education Perspectives Publisher: National League for Nursing, Inc. Audience: Academic; Professional Format: Magazine/Journal Subject: Education; Health; Social sciences Copyright: COPYRIGHT 2009 National League for Nursing, Inc. ISSN: 1536-5026
Date: May-June, 2009 Source Volume: 30 Source Issue: 3
Geographic Scope: United States Geographic Code: 1USA United States

Accession Number:
Full Text:
ABSTRACT The concept of innovation in nursing education has been addressed in published literature on faculty-defined and faculty-created teaching strategies and instructional methods. In this project, innovation is defined as "using knowledge to create ways and services that are new (or perceived as new) in order to transform systems" (Pardue, Tagliareni, Valiga, Davison-Price, & Orchowsky, 2005). Studies on nursing student perceptions of innovation are limited, and it is unclear how undergraduate and graduate students conceptualize innovative learning experiences. This project explored students' perceptions of their experiences with instructor-defined, innovative teaching/learning strategies in four types of nursing education programs. Issues nurse educators should consider as they apply new techniques to their teaching are discussed.

Key Words Innovative Teaching Strategies--Nursing Student Perceptions --Innovation--Nursing Education


HOW DO STUDENTS EXPERIENCE FACULTY-DEFINED, FACULTY-CREATED, INNOVATIVE TEACHING STRATEGIES? Comprehensive evaluation is needed to determine the effectiveness of innovations in nursing education as well as student responses to new methods of teaching. The project discussed here centers on the perceptions of nursing students in four types of nursing programs. It serves as a call to encourage further implementation and evaluation of innovative educational strategies.

Background Nursing education is in the midst of transformation influenced by a number of factors, including the widespread use of new technologies, the serious shortage of nurse faculty, and the realization that today's nursing students are a diverse group with multiple learning styles (Briggs, 2006). Faculty are challenged to capture the attention of the learner, to focus on what the learner knows, and to engage students in their own individual learning experiences. Simply imparting information through lectures is not sufficient (Dryden & Vos, 1999).

It is important to note that faculty and students may have different views of what constitutes innovative teaching. For the National League for Nursing (NLN) Task Group on Innovation in Nursing Education, innovation is defined as "using knowledge to create ways and services that are new (or perceived as new) in order to transform systems. It requires deconstructing (i.e., challenging) long-held assumptions and values. The outcome of innovation in nursing education is excellence in nursing practice and the development of a culture that supports risk-taking, creativity, and excellence" (Pardue, Tagliareni, Valiga, Davison-Price, & Orchowsky, 2005).

Faculty have created and implemented a number of new teaching strategies as noted in the following examples from the literature:

* Technological advances, including the use of simulation (Jeffries, 2005; Nehring & Lashley, 2004) and PDAs (Goldsworthy, Lawrence, & Goodman, 2006)

* New delivery methods, such as e-nursing education (Neuman, 2006) and nontraditional delivery methods (Boylston, Peters, & Lacey, 2004; Cangelosi & Whitt, 2005; Grady & Berkebile, 2004; Moore & Hart, 2004; Seibert, Guthrie, & Adamo, 2004)

* Various teaching-learning strategies (Bransford, Brown, & Cocking, 1999; Diekelmann, 2004; Glanville & Houde, 2004; Ironside, 2004; Mikol, 2005; Schaefer & Zygmont, 2003)

* Preferred learning styles and approaches (Fearing & Riley, 2005; Johnson & Romanello, 2005).

Studies of nursing students' perceptions are limited to the educator's role (Schoening, Sittner, & Todd, 2006); teacher behaviors (Berg & Lindseth, 2004; Viverais-Dresler & Kutschke, 2001); clinical experiences (Cooper, Taft & Thelen, 2005); online learning (Ali, Hodson-Carlton, & Ryan, 2004); and differences between undergraduate and graduate students in the use of technology (Billings, Skiba, & Connors, 2005). No studies were found that addressed nursing students' perceptions of faculty-defined innovative learning experiences.

The purpose of this project was to attempt to understand the definition of innovation as viewed and described by nursing students. The perceptions of these students can help conceptualize innovation and lead to the creation of new strategies that take into account unique program cultures, values, resources, behaviors, and beliefs.

Method Four members of the NLN Task Group on Innovation in Nursing Education, representing four program types (associate degree, baccalaureate, RN-BSN, and master's degree), volunteered to conduct an innovative project. The members of the task group defined the protocol. Faculty in each program had experienced transformative challenges resulting from the faculty shortage (open positions in these four programs ranged from 5 percent to 25 percent of budgeted positions), technology growth, and changes in the student body. Learners ranged from 20 to 50 years old or older; most were aged 20 to 29. Faculty, who saw a need to try something new, identified, defined, and implemented teacher-created strategies relevant to specific course objectives; these were viewed as innovative within the context of each program. Each strategy is presented by program type.

ASSOCIATE DEGREE Eleven students in a capstone medical-surgical clinical course researched and wrote a patient scenario for a human patient simulator. The goal of this project was to develop a critical thinking approach to use in the selection of nursing actions appropriate for the "rescue" of patients with acute health problems. The completed project engaged students in nursing care problem-solving activities that focused on the identification and application of interventions to prevent complications. Upon successful completion, students received honors points and a reduction in clinical rotation days. The project satisfied clinical course outcomes and students achieved clinical objectives.

TRADITIONAL BACCALAUREATE This innovative strategy differed from the standard class research project in two ways: a) it added an experiential component to the research project, and b) it fostered a collaborative research partnership with nurses at a community hospital. Two student groups volunteered to collaborate with nurses from two hospital units. Students and RNs together selected a practice issue current on the unit. Based on best practices emerging from a research literature analysis, students developed a best practice implementation plan. Students presented the results of their analyses and plans to the respective units and included the nurses' feedback in their final written projects.

RN-BSN The innovative assignment was incorporated into a required health assessment course. Sixteen students worked in self-selected small groups of four to five to create a project focused on health assessment of special populations (pediatric, geriatric, or peripartum). While the instructor functioned as a resource and guide, individual projects were initiated and developed according to the interests and learning needs of the students. The students also selected teaching and evaluation methods that would be used to assess peer learning.

MASTER'S The nine graduate students who participated in the project were adult nurse practitioner students and nurse educator students. The students worked with the state nurses association and traveled to the state capital to analyze different proposals presented to the legislature on health care reform, improvements, effects of benefits, and cost containment. The faculty creator of the project maintained contact with the students and recorded activities in a written journal. Rather than simply using the Internet as they would with a standard assignment, graduate students experienced working at the legislative level.

The students who participated in these teacher-defined innovative strategies were volunteers. After the strategy was implemented, group discussions were held to explore students' perceptions. At three of the sites, the discussions were led by a faculty facilitator (notes were taken by a recorder or the discussion was taped); at one site, students submitted written responses.

Student comments were transcribed into four narrative documents. The documents addressed responses to a series of open-ended questions designed to seek out how students experienced the innovation.

* What was your experience in taking the [name of] course?

* Describe the ways in which you were able to exercise creativity.

* How did the students learn together?

* How did the teacher demonstrate openness to new ideas/ perspectives/options?

* What experiences had the most impact on your learning?

* What concerns did you have about participating in this format?

* Describe your time commitment to this learning experience.

* How did the flexible approach compare to traditional course experiences?

Results The findings of this project reflect rich student response data and shared meanings about innovation. The data reflect careful deliberation, indicating that students appeared to weigh the pros and cons of the innovative strategies. The Ethnograph 5.08, a qualitative data analysis software package, provided the ability to read coded material within the context of the text and reflected both the intensity of statements and the commonality of responses among group participants.

The data are presented according to the prominent threads derived, both positive and negative. Sample quotes are provided to illustrate selected threads. They demonstrate the potential intent of the response and the shared meaning among different respondents.

Student Experienced Positive Attributes of Innovation STRATEGIES Strategies were described as worthwhile, enhancing student learning: "I think this pushed me to do and learn more"; "The experience left me feeling excited"; "It was informative and interesting"; "Refreshing--so many other classes are 'sit and listen'"

Many of the students saw the innovative strategies as adjuncts to traditional methods: "Lecture and class discussion and exercises helped to understand the book better"; "I feel like I learned a lot in a short period of time." A student involved in a research experience declared: "Overall, I feel I gained more knowledge through seeking out resources which helped me gain insight and the ability to synthesize large volumes of new information" A student in a policy course stated: "This course opened my eyes to the political arena of health care" One student stated: "I was a little worried at first because of the time spent. I work a lot of hours and did not know how I would accomplish this. But anything that takes me to the next level or challenge--I will not turn down."

CONTEXT Students saw positive aspects of group work: "I am glad to have been in this group and learned about leadership and team work"; "It prepares you as a student to how it will be in the field. Either you get busy and accomplish what you set your sight on or you fall behind." Students also expressed views about the contributions of others: "Each student brought new ideas and different experiences to the table"; "It was good for me. I like to hear other people's opinions on subjects. It really helps me grow"; "I always like working with other students because sometimes they pick up on something I could have missed"; "I think that each student ... had diverse backgrounds that enhanced our group."

Others commented that their responses to group work were largely impacted by the makeup of the group: "Fortunately the group I was in had some really hard workers that could stay on task and remain focused"; "Overall the clinical group I was in was a smart team that worked together to accomplish whatever was needed." One student described a lack of experience with group work.

The relaxed atmosphere created by the innovative strategies was also seen as positive. "There was time to let it sink in"; "Students learn together in every class--a lot of ideas helpful--a lot of perspectives"; "Helped if one had questions--others could help out.... More apt to ask fellow students--less likely to feel 'stupid.' Could ask about the experiences of other students."

Other positive comments focused on the flexibility associated with the innovative strategies, particularly with online discussions: "The luxury of taking my time to respond and/or make comment about the other nurses' entries [was a plus]"; "All of us were able to read [at our leisure] responses of each other and therefore our knowledge was shared, even if we didn't feel compelled to respond to all entries"; "I could work at my pace and around my full-time job commitment." The flexibility was appreciated: "Flexibility allowed more room to do things--for example, change a test date--in some courses this is not even considered"; "It gave us the charge as individuals to work at our own pace and also gave us wider boundaries to explore different kinds of learning."

RESOURCES Students appreciated the resources available, including various forms of simulation and interactive equipment: "The dummy was great. His tongue, heart, lungs, pulses, and blood pressure all played a role in our scenario"; "Working on the manikin was great because it honed us on skills that I need to remain in shape" Students saw the strategies as a way to review for exams and reinforce skills: "Providing class notes prior to or after the lectures"; "We did an interactive learning activity via the Internet."

ROLES The most commonly shared positive responses were about the active role students played in the teaching-learning process. Students referred to the stimulation of their creativity and stated that the clinical agency experiences, the hands-on skill demonstration, and the opportunity to apply theory in practice all keyed heavily in their response to the strategy: "Even though our 'patient' [in one case scenario] coded, we directed others to add some interesting and humorous things to hold their interest"; "I got a chance to actually do some of the things I have only been able to watch up until now"; "Comprehensive assessment brought everything together--helped to learn the content"; "The case scenario development was an experience of bringing knowledge about what we learned and be able to apply it to practice." Clinical experiences were described as having the most impact, helping students become comfortable with critical patients.

As may be anticipated, the human element figured into the students' responses: "First, having a good preceptor in the emergency room was the best"; "With the help of amazing nurse was able to get it the first time"; "I worked with my first male nurse and was very impressed." Accolades for the teacher/faculty included such comments as: "Teacher tried to create a hands-on environment"; "The teacher brought in her experiences to help make connections"; "She was open to let us do what we wanted to do." Though a significant amount of time was devoted to each initiative, the students generally indicated that they felt rewarded with new knowledge and skills: "It was a more interactive learning process which allowed me to put myself at the bedside and make critical thinking decisions on exams:' The students discussed what it meant to have increased responsibility: "The teacher set the direction, then students had to figure it out"; "We were given certain parameters, but were mostly on our own."

Student Experienced Negative Attributes of Innovation STRATEGIES Students frequently spoke of the stress in their lives and the emotional issues experienced during their studies. It was difficult to determine whether these innovative strategies led to this response or if stress was simply an inherent part of nursing student life.

Some negative comments related to the strategy itself: "Would have liked the assessments to be more nursing-focused, to include interventions related to specific assessment findings"; "I don't think it is going to help on NCLEX"; "Test questions were unclear."

Students had negative responses to their role in active learning strategies: "It was difficult to take the role of teacher--tough to think about how to get others to learn"; "Are we teaching what the other students need to know?" One student noted: "We learned by discussion in class, when it should have been lecture."

Students saw the replacement of clinical experiences/time with other strategies as a negative factor: "I honestly felt a bit nervous about a pilot program that put me out of my typical clinical rotation comfort zone"; "I had mixed feelings about missing hands-on clinical experience in exchange for researching patient scenarios. I was hopeful that time spent researching with my group would enlighten me to following algorithms correctly and effectively."

Other students commented on their difficulty learning psychomotor skills, whether in the clinical area or in the lab setting: "There seems to be something more to a skill than watching it and talking about it. I do a lot better with hands-on learning"; "I would have liked to be 'shown more" i.e., demonstration:' Students taking the research course felt it was "just not as important" as courses such as med-surg and pharmacology. Although one student commented that the evidence base for doing nursing is important for all nurses, another stated, "If you don't plan on doing research, you shouldn't have to do it"

CONTEXT Group work was an area of frustration for some students: "In my opinion everyone should participate in the project and have assignments ready and then bring them up to the group for discussion. We struggled as a group"; "The problem seemed to be getting everyone to show up on assigned days"; "One person in our group was disorganized and did not complete their portion of the case scenarios. That affected our group work and the completion of our project."

Group dynamics figured into the success of the group work: "As often happens in groups, one member decided to take over meeting times, delegation of responsibilities, and actions. Many factors of this 'self-imposed leader' were annoying." Other aspects of group work were seen as negatives: "I did not like the group work in class. Essentially we missed out on the other groups' topics. I would rather hear the whole lecture over the topic than learn a small piece in a group." Group size also was a key factor: "One computer and PDA requires a smaller group of people"; "Groups should have no more than four people, six people is too many to work."

Some participants did not like the time commitment required with the new learning strategies: "I do feel that this could have been accomplished in less time"; "Sometimes people would ask misleading or irrelevant questions that just ended up confusing me." Students questioned whether the amount of work required was commensurate with the credit awarded. "It took a lot of time to make all those trips plus write all papers--for a two-credit course"; "I had to take off work two days:' Conflicts with other priorities seeped into the data: "During our presentation we knew the students were not interested in the scenarios because of finals"; "I think this [innovative strategy] should have been saved for younger students with less responsibilities."

The time commitment required for the innovative teaching strategies varied, and it is difficult to know for sure whether the time invested differed from courses taught with traditional methods. Generally, these strategies seemed to take slightly more to much more time than traditional classes. One student stated: "Due to my lack of knowledge about the political arena and health care systems, I would have to express that I put forth a greater amount of time and effort than I would expect a two-credit course requires" Others commented: "It was not my priority so I didn't put a lot of time into it"; "There was not much time during class time for the project."

RESOURCES Some students stated that they did not see the online course as having value. One student claimed that in the online discussions, "The teacher would not know my participation." Several noted frustration with the equipment and resources: "Two days the equipment was not charged and the software wasn't loaded"; "We found out that the manikin program will not do what we thought it was going to do"; "We continued to have problems with programming and equipment troubles, which caused a lot of group frustration"; "I was concerned about understanding how to use the program and trying to pull it all together." Another student stated, "My work with the PDA was educational, but once again I enjoyed my clinicals in the hospital much more."

Equipment issues were coupled with instructor accessibility: "We came up to school to work on the assigned project, but when equipment didn't work or problems were experienced, or simply when the group needed clarification there was no instructor around" Perhaps most meaningful was the comment, "It seemed like we spent a lot of time learning how to program [the manikin] and less time learning clinical information." Students also described having difficulties with an assigned text.

ROLES The students cited discontent and frustration with some of the teachers, their teaching styles, and their organization: "The teacher was not very involved"; " ... not much teaching or direction regarding the use of the [manikin] program." Other negative comments were directed at the staff who participated in the project: "The nurses were there because they were told to be there. Nurses were negative at the end of the project as well. Nurses did not have information ... they were burdened with the thought of change."

A common thread noted was the need for clear instructions and explanations about the project/strategy as well as disclosure of faculty expectations. "The whole thing could have been more prepared and had a better presentation"; "No specifics were provided for the group. Felt lost at times"; "I felt there was little guidance, poor preparation, and felt that as a result my time would have been better spent in the critical environment with actual patients and nursing staff willing to teach."

Project Limitations Certain factors contributed to limitations in the rigor of this project. The group discussions were designed to allow for interaction among participants, but the data sources varied; they included a videocassette, a portion of a CD, and brief written responses. In contrast, the data were detailed and sufficiently rich to uncover emerging themes and trends in student responses. The themes were quite pervasive. Important quotations were derived to substantiate the messages obtained.

Implications for Nursing Education Emerging themes obtained from the data were strategies, context, resources, and roles. Nursing students characterized innovative teaching/learning environments and strategies as those that excite, refresh, and open their eyes. The environment prepares students for practice, offers wide boundaries to explore, and allows alternative perspectives, empowering the student to be in charge of time and pace. Resources help students review for exams, provide notes prior to or after the lecture, and support interactive learning or learning via the Internet. Students desire an active role, some humor to hold their interest, good preceptors and staff, hands-on practice, teachers who share their experiences and help make connections, faculty who are open and accept student guidance, and stated parameters that allow independence. Some students were noted to embrace the challenge associated with something new and experimental.

While students praised the flexibility, interactive work, and the challenges and independence inherent in innovative teaching strategies, some students were disappointed at the lack of help with exams, the time schedule, equipment problems, and unclear directions and expectations.

It may be that the best way to implement innovation is to take into consideration that students experience positive and negative attributes of innovation in the context of each program's unique culture, values, resources, behaviors, and beliefs. What works for one program may not work for others. Resistance to change, time constraints, personal learning styles, and life events must be considered. The experiences of these students provide perceptions of the positive and negative attributes of innovation. It is hoped that they will offer valuable insight for the development and implementation of innovative teaching strategies for nursing students.


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This article was submitted by the NLN Task Group on Innovation in Nursing Education. Lois H. Neuman, PhD, RN, is faculty at Montgomery College, Rockville, Maryland. Karen T. Pardue, MSN, RN, CNE, ANEE is interim director and associate professor, Department of Nursing and Health Service Management, University of New England, Portland, Maine. Janet L. Grady, DrPH, RN, ANEF, is director and associate professor, Nursing Program, University of Pittsburgh at Johnstown, Pennsylvania. Mary Tod Gray, PhD, RN, is an associate professor, East Stroudsburg University Department of Nursing, East Stroudsburg, Pennsylvania. Bonnie Hobbins, MS, RN, is testing manager, Elsevier Review and Testing, Houston, Texas. Jan Edelstein, EdD, RN-CS, is a professor, Marian University School of Nursing, Fond du Lac, Wisconsin. Judith W. Herrman, PhD, RN, is assistant director, University of Delaware School of Nursing, Newark. The authors are grateful to the NLN Special Grant Research Program; Mount Aloysius College RN-BSN Program; Kim Carman, MSN, RN, CRNP, Angela Vauler EdD, and Corinna Dotter, ND, RN, MSN, East Stroudsburg University; the Pocono Medical Center, East Stroudsburg; Dolores Yundt, MSN, RN, Theresa Croushore, MSN, RN, Alexander Press, BSN, RN, Marian College MSN Program; Gina Dennik-Champion, Executive Director, Wisconsin Nurses Association; and P. Lea Monahan, PhD, RN, CNE, Western Illinois University. Write to Lois. Neuman@Montgomery College.edu or lhneumanconsultants@verizon.net for more information.
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