Since the transition of nursing education to college/university level, a persistent problem facing nurse educators has been that of research training for students. Australian schools of nursing, like their US counterparts (Price & Thomas, 1979, cited in Laschinger et al., 1990), have introduced courses in nursing research at second- and thirdyear levels of pre- and post-licensure baccalaureate courses.
Introducing courses in nursing research is not the same as fostering a positive attitude toward active research. While these courses may focus on producing more critical consumers of research, students often perceive the carrying-out of research and data collection as solely the work of nurse academics (Laschinger et al., 1990). Students question the relevance of research methods and data collection to their future careers as nurses (Kessenich, 1996; Kirchhoff, 1991). Students also may be trained to be collectors of data but not users of that data in their practice (Morse et al., 1996; Floyd, 1996).
Many creative approaches have been used to overcome student resistance to education in research methods, such as chart reviews (Neidich 1990), the "Researcher for a Day" project (Blenner, 1991), field trips (Kirchhoff, 1991), and a variety of classroom simulations designed to overcome Waddell's "research is hell" myth (Wagnild, 1992; Waddell et al., 1994; Pond, 1996). A major problem identified by many researchers is the students' inability to see research as a part of "real nursing," an integrated element of nursing practice (Pond, 1996; Bostrom et al., 1991; Morse et al., 1996; Laschinger et al., 1990; Neidich, 1990; Blenner, 1991; Kirchhoff, 1991). Neidich (1990:139) suggests that student involvement in a research project, following classroom work on foundational principles, helps to influence student perceptions of research relevance. Above all, the literature indicates generally that student involvement in the research process fosters a more positive attitude to research in nursing (Laschinger et al., 1990).
Pond (1996, citing Overfield & Duffy, 1984) indicates that strategies used to foster a research mentality among nursing students fall into three main groups: learn by doing, learn by proposing, and learn by critiquing. Kirchhoff (1991, p. 90) suggests that classroom activities that allow students to visualize themselves participating in research may be a valuable exercise in overcoming research inertia. We combined these two approaches, asking students to develop and engage in their own integrated and critically aware practiceresearch-data collection process. Our choice was to use a Health Market (Bull & Martyr, 1998), run as part of the Year 2 Unit Scientific Perspectives in Nursing, as a means of integrating practice, research, and data collection skills.
PREPARATION FOR THE MARKET
Briefly, the Market was an out-of-classroom practical experiment in public health education at the University of Tasmania's Launceston campus. The overall design consisted of a number of individual stalls set up by the students using school of nursing equipment such as tables, display boards, and so forth. The stalls were designed to fit around the free floor space at the university cafeteria at the Launceston campus. This meant that the target audience for the Market would be students at that campus, and to obtain a good representation of this population, we chose to run the Market during the lunch hour.
We chose the major topics for each Market stall: rural health, cardiac health (2 stalls), respiratory health (2 stalls), sexual health (3 stalls), nutrition, diabetes, road safety, drugs and alcohol, child growth and development, complementary therapies, stress management, basic life support, sun safety, and immunization. We then allowed students to self-select into groups that reflected a personal interest (Laschinger et al., 1990, p. 114) as well as timetable suitability. As part of their final assessment, we asked students to submit a written report on the Market, including a measurement of how effective their stall had been. To do this, students had to devise various means of collecting data from members of the public, both on their particular health issue and on how much visitors to the stall had learned.
We had already fostered a critical consumption of research, because students tailored their health issue for their audience using relevant epidemiological findings (Friis & Sellers, 1996). Students researched the demographic background of the university population using the university statistics website. This was then correlated with literature on the health of the Taemanian population. Students were also asked to hand in a detailed plan for their stall six weeks prior to the Market. This included all surveys and tests that they would be conducting, and alerted us to any areas that needed rethinking.
The object of the exercise was to overcome the fear of research and data collection, and to promote the integration of data collection into nursing practice (Bostrom et al., 1991). We asked students to suggest their own sampling and data collection methods, and to explain why they had chosen these methods (Laschinger et al., 1990, p. 116). We also encouraged critical thinking about what information the individual groups were trying to elicit from their audience, allowing this to drive the survey design. Some groups chose to survey the population and test for health risks; almost all groups chose to survey the level of successful education provided by their stall. To maximize returns, we encouraged students to make their surveys brief, ideally restricted to one double-sided page.
The purpose of the exercise was to show students that research and data collection can be integrated into nursing practice. However, since the fact that the Market was being run in a learning environment, there were factors that limited the collection of controlled and valid data that would help construct a university health profile. These included ethical considerations, which impeded the conduct of invasive (although possibly more accurate) testing and screening procedures. For example, an early plan by the Diabetes group to undertake on-the-spot urinalysis had to be put aside because of possible health risks. These and other university ethical research policies placed necessary limits on the types of data to be collected. The object of the exercise was instead to promote an integrated doingproposing-critiquing approach to nursing research in practice.
Each group was asked to present their data in a report on their learning experiences at the Market. The data were collected by the students in the form of surveys they had designed to help them evaluate the success of their health education techniques at the Market. We reported the findings from ten groups because not all groups presented their data in their final report. The groups who presented data were: Complementary Health, Motor Vehicle Accidents, Rural Health, Respiratory 1 (asthma), Cardiac 1 (heart function), Child Health and Development, Diabetes, Drug and Alcohol, Stress Management, and Sexual Health 2 (organic disorders). For evaluation of their stall, almost all of the above groups chose a combination of yes/no, multiple choice, and short answer questions. An exception was the Complementary Health group, who instead collected general written comments from their audience.
Some groups reported a clear success in their educational aims- the Motor Vehicle Accidents group found that their presentation was highly effective in alerting people to their personal risk of road accidents. The Cardiac group had aimed to educate what their literature search revealed as a neglected area- those under 30 years old and female. Their data collection showed that 76% of those who attended and completed the survey were under 30, and 66% of the under-30 group were female. The group reported this as a successful health promotion outcome.
The group focusing on Rural Health collected both qualitative and quantitative data. One member of the group reported that her one-to-one conversations on farming injuries had been very useful: "Many of these people commented that it was something they had never realized- so something must have been learned." The group also collected 50 surveys, more than half of which were overwhelmingly positive on the content and educational value of the stall.
Five of the ten groups were openly critical of the means they used to collect data and the results generated by this. For example, Respiratory 1 collected data from male and female asthmatics and tested their lung capacity. Group members later presented data with critical comments on possible biases that may have influenced outcomes, such as the high level of medical control of asthma, and the limited sample. Child Health and Development found that although their demographic research indicated that the majority of students at the campus were over age 24, very few people visited their stall at the Health Market. Consequently, very few members of their targeted public evaluated their stall's effectiveness.
Students were perceptive in their discussion of possible biases. The Diabetes group reported that while the results of their evaluation survey suggested they had been successful in educating the public, several factors indicated otherwise: many people simply filled in the forms without reading the information, those most in need of education did not attend the stall, and a high proportion of fellow nursing students were completing the forms in an attempt at quid-pro-quo for their own stall surveys. The group promoting Stress Management reported that people generally gave the answer "that stall holders wanted to hear" (student comment); consequently, their results were inconclusive. This group indicated that a more specific questionnaire might overcome this. The Drug and Alcohol group found that their use of terminology on their survey misled some participants, and that for future use a scale of responses rather than a yes/no option would be more valuable.
A number of groups had arranged for incentives to be offered at their stall to encourage people to complete their surveys. Before the Market, this had been a high priority and had captivated the students' imaginations. Afterwards, several groups were critical of their reliance on this means of attracting a sample. A student from the Child Health and Development group commented that "Many of them only came because we bribed them." Another student from Sexual Health 2 commented, "We were giving away Mars bars as prizes."
Overall, we were pleased with the results. Students acquired valuable skills in creating tools for data collection in a health promotion context. They participated in research in a practice context, which may help positively affect their future attitudes to research. Above all, they learned to be critical of their own data collection methods. Evaluation of student attitudes towards research will be ongoing, because this is an element of our study that was not integrated in the pilot exercise. We may survey students before the Market, at the beginning of second semester, and then after the Market exercise, to chart changes in perception of research and its role in nursing.
The approach deecribed in this article seems to be a useful means of introducing students to research and data collection as an integrated part of nursing practice. The strategy encourages studente to be creative, to develop insight into areas of health that need to be addressed, and to exerciae many of the practical reeearch ekills they have learned during their nursing reeearch course. It also allows them to be critical of their own research design, and to suggest improvements. It is especially well suited to pre-licensure and undergraduate students, who can then move on to higher levels in the course and further develop their data collection and analysis skills. Above all, it fosters "learning by doing," which may help many nursing students to feel more confident in undertaking research at a later stage in their careers.
- Blenner, J. (1991). Researcher for a day: A simulation game. Nurse Educator, /6X2), 32-35.
- Bostrom, J., Dibble, S., & Rizzuto, C. (1991). Data collection as an educational process. Journal of Continuing Education in Nursing, 22(6), 248-253.
- Bull, R., & Martyr, P. (1999). This little piggy went to market: Using a health market as a learning strategy for pre-registration bachelor of nursing students. Nurse Education Today, 19(2), 116-121.
- Floyd, J. (1996). An undergraduate reeearch course: Emphasis on research utilization. Journal of Nursing Education, 35(4), 185187.
- Kessenich, C. (1996). Bringing reality to the research classroom. Journal of Nursing Education, 35(4), 187-188.
- Kirchhoff, K-, & Stager, J. (1991). The use of field tripe in teaching nursing research. Journal of Nursing Education, 30X2), 89-90.
- Laschinger, H., Johnson, G., & Kohr, R. (1990). Building undergraduate nursing students' knowledge of the research process in nursing. Journal of Nursing Education, 29(3), 114-117.
- Morse, W., Oleson, M., Duffy, L., Patek, A, & Sohr, G. (1996). Connecting the research and nursing processes: Making a difference in baccalaureate students' attitudes and abilities. Journal of Nursing Education, 35(4):148-151.
- Neidich, B. (1990). A method to facilitate student interest in research: Chart review. Journal of Nursing Education, 29(3), 139-140.
- Pond, E., Bradshaw, M. (1996). Attitudes of nursing students toward research: A participatory exercise. Journal of Nursing Education, 35(4), 182-185.
- Waddell, D., Summers, A., & Hummel, M. (1994). Creative strategies for teaching nursing research. Nurse Educator, 19(5), 5-6.
- Wagnild, G. (1992). Research quest: A research teaching method. Journal of Nursing Education, 31(9), 425-426.