Journal of Nursing Education

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Educational Innovations 

Transforming the Nursing Curriculum to Promote Critical Thinking Online

Gina Lynn Anderson, MS; Catherine A. Tredway, MBA, MS, RN

Abstract

With the expansion of online nursing courses and programs, many nurse educators are faced with the challenge of designing online courses. This article provides an example of how traditional face-to-face nursing content was transformed into an online problem-based learning experience. A framework and specific course examples are provided to help with the redesign process. The article concludes with the instructor and instructional designer sharing lessons learned from this experience and recommendations for future course designers.

Abstract

With the expansion of online nursing courses and programs, many nurse educators are faced with the challenge of designing online courses. This article provides an example of how traditional face-to-face nursing content was transformed into an online problem-based learning experience. A framework and specific course examples are provided to help with the redesign process. The article concludes with the instructor and instructional designer sharing lessons learned from this experience and recommendations for future course designers.

Ms. Anderson is Instructional Design Consultant, University of Illinois, Global Campus, Champaign-Urbana, and Ms. Tredway is Clinical Instructor, University of Illinois at Chicago, College of Nursing, Moline, Illinois.

Address correspondence to Gina Lynn Anderson, MS, Instructional Design Consultant, 50849 Hawthorne Meadows, South Bend, IN 46628; e-mail: ganders6@gmail.com.

Received: October 25, 2007
Accepted: February 03, 2008

RN-to-BSN completion programs in nursing are becoming increasingly popular nationwide to address the need for advanced formal education to enhance critical thinking and problem solving. The expansion in the scope of nursing practice and the growth in autonomy of nurses results in a growing demand for expanded critical thinking, problem solving, and decision making abilities. According to Martin (2002):

A call has gone out for changes in teaching methods to provide for the development of critical thinking skills. (p. 243)

This call coincides with an increasing demand for the accessibility of online courses. The challenge persists for faculty and instructional designers to take existing course material and transform it into engaging online learning experiences that promote critical thinking. The virtual classroom may present many obstacles for faculty who have traditionally taught face to face. This article describes how an instructional designer and a faculty member transformed one course from a traditional classroom RN-to-BSN course with lectures, quizzes, and tests to an online problem-based learning (PBL) experience that addressed critical thinking and problem solving.

Course Overview

Concepts and Processes in Contemporary Nursing is an introductory-level course for RN-to-BSN completion students. It specifically covers the concepts of adaptation, caring, culture, ethics, law, lifespan, role, and science and uses the processes of communication, critical thinking, leadership, management, the nursing process, and teaching and learning. Traditionally, students were required to attend scheduled classroom sessions, read textbooks and nursing literature, listen to lectures explaining the readings, participate in classroom discussion facilitated by the instructor, write papers that apply the concepts, and take quizzes and examinations on course material.

A Framework for Course Design

The instructional designer suggested the use of PBL as the means to redesign the traditional face-to-face experience. Problem-based learning is an effective instructional approach first developed for use in health science fields to immerse students in complex situations (Barrows & Tamblyn, 1980) and has been identified as one of the most promising approaches for teaching nurses (Creedy, Horsfall, & Hand, 1992; Rideout & Carpio, 2001). This instructional approach challenges students to think critically and analytically (Boud & Feletti, 1998; Duch, Groh, & Allen, 2001; Ericksen, 1984; Weigel, 2002). Research has shown that PBL promotes higher order thinking, motivates students to engage in content, encourages collaboration, and anchors learning in real-world contexts (Good & Brophy, 1991; Jonassen, 1999; Savery & Duffy, 1995). Students immersed in such constructivist environments formulate their own understanding of the material, thus making the experience meaningful for each student (Duffy & Jonassen, 1992). This has proven to be true in many different disciplines in higher education, including nursing (Rideout & Carpio, 2001). As Tompkins (2001) stated, nurses need to be pushed to think in complex ways to practice nursing in the 21st century.

Although many authors defined the steps of PBL in different ways (Barrows & Tamblyn, 1980; Davis & Harden, 1999; Rideout & Carpio, 2001; Schmidt, 1983), there is a general consensus of the essential characteristics of PBL, such as:

  • Students are presented with a problem that is central to the learning experience.
  • Students are engaged as stakeholders in the problem.
  • Students are immersed in a self-directed learning experience in which they have control over and responsibility for their learning.
  • Students examine multiple perspectives on a topic, issue, or problem.
  • Students interact in small groups to engage in critical thinking and discourse.
  • Students reflect on what they have learned and apply new knowledge and understanding to the problem.
  • Facilitators coach students through the experience by guiding student inquiry.

Transforming the Course

To begin the transformation of the course from its traditional design and delivery to a problem-based design, the instructional designer (G.L.A.) encouraged the faculty member (C.A.T.) to first consider the desired course outcomes and enduring understandings. Wiggins and McTighe (1998) defined enduring understandings as the essential concepts students should retain, whereas specific content details are forgotten. In other words, what did the faculty member want the students to understand the most and remember after the course? Wiggins and McTighe (1998) identified this decision as the first step in the instructional design process known as backward design. According to Wiggins and McTighe (1998), the backward design process has three stages:

identify desired results, determine acceptable evidence, and plan learning experiences and instruction. (p. 9)

Identify Desired Results

By reviewing and discussing the course objectives and materials, it was determined that the desired result for the students, who were practicing nurses already, was to better understand and to articulate what nursing is and what it means to be a nurse. These desired results are not only worth understanding because of their direct implication for the nursing profession, but also because the content holds great potential for engagement because it gets to the heart of what it means to be a nurse. Wiggins and McTighe (1998) reported that when nurse educators anchor content to big ideas that connect to students’ interests, a greater potential of engagement and sustained inquiry exists. Thus, after contemplation of course content, extensive course material was collapsed into the prevailing question, What is nursing?

Determine Acceptable Evidence

Next, in the backward design process, course designers typically determine how students demonstrate “acceptable evidence” of student understanding. On the basis of the desired results and enduring understandings for the course, the faculty member determined that:

Students should be able to articulate what nursing is and what it means to be a nurse.

Students show their understanding by engaging in meaningful discourse with classmates, producing individual and group artifacts, and providing thoughtful reflection. Students would then apply what they learned to a culminating activity that anchors the PBL experience.

The instructional designer and faculty member brainstormed authentic challenges or problems that reflected the desired result of the course and that might engage students as invested stakeholders in the course. They decided to have students work in groups to develop a professional presentation for the National Student Nurse Association (NSNA). The group presentation that would be selected and posted on the NSNA Web site ( http://www.nsna.org) best answered the question, What is Nursing? The NSNA is an organization that mentors the professional development of nursing students. Research shows student engagement increases when the assigned tasks have direct implication to their lives (Wiggins & McTighe, 1998). However, with this course being offered online every 8 weeks with different faculty facilitating the course content, and with turnover at the NSNA, the course designers decided to transform this idea into a hypothetical authentic activity. Students would create the professional development for the NSNA board but it would not actually be posted on the Web site. Instead, the students would play the role of the NSNA board and select the best professional development presentation.

Plan Learning Experiences and Instruction

The next step in the backward design process is to design the units of instruction. To convert the course from a traditional 16-week format to an 8-week online format, the faculty member needed to group major course topics together. This resulted in 6 modules, which were given working titles and an estimated length of time for completion. Each module needed to reflect the course objectives and engage students in the contemplation of the enduring understandings of the course. The characteristics of PBL also needed to be embedded into each module’s design.

A flexibly adaptive course design was created to put the essential characteristics of PBL into action. According to Schwartz, Lin, Brophy, and Bransford (1999), flexibly adaptive designs create a balance between teaching methods in which students are provided little or no guidance and ones that reflect a more traditional style, where the instructor controls most aspects of student learning. The conversion of the Concepts and Processes course required this delicate balance. Thus, the instructional designer suggested a flexibly adaptive design called the challenge cycle to achieve this balance between the traditional direction and support and an environment in which the essentials of PBL could flourish online. The challenge cycle design gave students some structure in what is, due to the nature of problems, an ill-structured environment. This is not a new idea and has been implemented successfully in other disciplines (Barron et al., 1998; Veron & Blake, 1992; Weigel, 2002). The challenge cycle allowed students to experience multiple perspectives, coaching, small group discourse, critical thinking, and reflection, but also provided students with an overarching week-to-week structure to organize their learning experience. The subheadings below provide the challenge cycle’s weekly elements, course examples, and the addressed PBL characteristics.

Module Overview. The module overview introduced a weekly challenge or problem and engaged the students as stakeholders. In the first module, students were reminded that the Board of Directors of the NSNA is requesting an exemplary presentation to be given to nursing students answering the question, What is Nursing? The student groups begin work on that presentation by being challenged with the question, What is the Definition of Nursing? The groups’ focus is to come up with a working definition of nursing. The PBL characteristics included presentation to students of a problem central to the learning experience and engagement of students as stakeholders in the problem.

Goals and Materials. The goals and materials element identified the module goals and listed the kind of materials the students will need to access. The PBL characteristics included immersion of students in a self-directed learning experience in which they have control over and responsibility for their learning.

Challenge Element. The challenge element presented a challenge question for students to consider, related to the culminating activity of the course. During the first module, students were challenged to formulate a working definition of nursing for the Board of Directors. They began by examining their own beliefs. The PBL characteristics included immersion of students in a self-directed learning experience in which they have control over and responsibility for their learning and presentation to students of a problem central to the learning experience.

Generating Ideas. Generating ideas gave students a chance to demonstrate prior knowledge on the topic individually and in their group. Students took the time to reflect in their own journal and then discussed specific questions within their group forums. The PBL characteristics included reflection of students on what they have learned and application of new knowledge and understanding to the problem.

Resources and Perspectives. Resources and perspectives provided an organized place for students to find resources to explore and alternative perspectives to consider. Course examples included Web sites, interactive Adobe Flash® elements, videos on different perspectives, readings, and an online nurse consultant. Students determined how deeply they each explored the resources. The PBL characteristics included immersion of students in a self-directed learning experience in which they have control over and responsibility for their learning; examination of students’ of multiple perspectives on a topic, issue, or problem; and coaching of students by facilitators through the experience guiding student inquiry.

Action. Action presented the students with designated individual and team tasks designed to immerse them in the weekly challenge. For example, in the first module, students analyzed several definitions of nursing. Then each individual provided the team with the top three to five key concepts they believed necessary in a definition of nursing. For the team activity, students explored everyone’s concepts and decide on the top five to include. The team leader then composed a memo for the NSNA Board of Directors, including the team’s initial definition of nursing. The PBL characteristics included student interaction in small groups to engage in critical thinking and discourse.

Review and Reflect. Revision and reflection gave students the opportunity to reflect on what they have learned during the module. After students complete the weekly task, they are provided with questions to think about and to answer in their online journals. The PBL characteristics included reflection of students on what they have learned, application of new knowledge and understanding to the problem, and coaching of students by facilitators through the experience guiding student inquiry.

Module Checklist. The module checklist allowed students to check a bulleted list of the module’s activities so they could track assignments. The PBL characteristics included immersion of students in a self-directed learning experience in which they have control over and responsibility for their learning.

Recommendations and Lessons Learned

Both the instructional designer and the faculty member involved in the conversion of this course learned valuable lessons and have some recommendations.

Instructional Designer Recommendations

Some instructional designers can be quick to assume that faculty will have a hard time letting go of traditional teaching methods and models. Instructional designers should not begin the development project assuming faculty members are not open to change. Instead, the faculty member may not be familiar with the design process or different instructional models or theories. Faculty might shy away from other approaches because they are not experts in other instructional models. It is the role of the instructional designer to suggest how to approach the development process and provide ways to present the content. The instructional designer found that when faculty who are passionate about their content and experts in their field are willing to explore unfamiliar instructional models, powerful learning experiences can result.

Instructional designers should not try to become experts in the content field in which they are working. Instead, instructional designers should lean on faculty for content knowledge and faculty should lean on instructional designers for design suggestions. Instructional designers should consider all the ways content can be presented and how technology can be used to enhance the learning experience. Faculty may not be exposed to the vast technology tools that are always emerging in the instructional design field. Thus, instructional designers should not feel intimidated by suggesting alternative technologies to enhance content delivery. When faculty who know the content well discover the kinds of technology tools available, they are able to take their courses to new levels of sophistication. If instructional designers and faculty are willing to build on each other’s strengths, it creates the potential for strong synergy of individual contribution.

Nursing Faculty Recommendations

An elemental positive outcome to the conversion of the course is that it made the faculty member reconsider the key issues of the course. It was helpful to have a committed instructional designer ask questions that guided this evaluation. After the desired results and enduring understandings were articulated, it was easier to envision numerous ways of presenting the course material, other than the didactic “sage from the stage” method of content delivery.

With problem-based application of the material, students learn by doing. This notion is not uncommon in nursing education. At the diploma and associate degree level, nursing students must put into practice what they have read and learned in the course. There is no reason to change this method because the RN-to-BSN degree courses are more conceptual than clinical. Problem-based learning changes the purely conceptual into the clinical application of the content and students, not surprisingly, become engaged and can make real-world applications of the material.

Critical thinking is enhanced by requiring students to actually practice it in the course. In PBL, the students must apply their new knowledge to the identification and solution of a problem. This requires students to evaluate information gained through assigned readings and course content and to communicate within small groups, to listen to other ideas, to consider assumptions and evidence, and to analyze material.

The course instructor must trust that students are competent to learn in nontraditional formats. The challenge cycle design provided the material necessary for students to be exposed to course content. The instructor had to give up the traditional practice of repeating, in lecture format, what the student has read in the required reading assignments. Replacing lecture with personal reflection on the topic and individual and group tasks required students to use the information, not just sit and absorb a repeat of it. The faculty member’s willingness to forgo the traditional lecture format was stimulated and enhanced by the instructional designer identifying methods of highlighting key issues for students through audio perspectives, interactive written Flash presentations, and an audio nurse consultant answering frequently asked questions.

Finally, nursing faculty charged with the task of converting courses to an online format should request the assistance of an instructional design specialist. Faculty in all disciplines find their time consumed with course delivery, student advising, professional development, and departmental responsibilities. There is no time to become experts in instructional design as well, nor should this be done given that partnerships between faculty and instructional designers can be implemented. Universities, colleges, and even larger departments which envision course conversion and are interested in cutting edge teaching methods should consider employing instructional designers to support faculty.

Conclusion

Redesigning traditional courses may present obstacles for faculty who are charged with the task of putting content online. It may be difficult for faculty members who have taught in traditional classrooms to foresee the complexities of online learning. This article offers an approach to a course redesign from a problem-based perspective. It begins with a course overview and a description of a framework for course design. Next, an example of the course transformation is described, followed by recommendations and lessons learned. This model can be applied to future nursing courses to promote critical thinking online.

References

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Authors

Ms. Anderson is Instructional Design Consultant, University of Illinois, Global Campus, Champaign-Urbana, and Ms. Tredway is Clinical Instructor, University of Illinois at Chicago, College of Nursing, Moline, Illinois.

Address correspondence to Gina Lynn Anderson, MS, Instructional Design Consultant, 50849 Hawthorne Meadows, South Bend, IN 46628; e-mail: .ganders6@gmail.com

10.3928/01484834-20090201-01

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