Journal of Nursing Education

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Syllabus Selection: Innovative Learning Activity 

Evidence-Based Practice to Outcomes Management: Spiraled Learning Activities, Part II

Joanne Noone, PhD, RN

Evidence-Based Practice to Outcomes Management: Spiraled Learning Activities, Part II

In an article by Ross, Noone, Luce, and Sideras (2009) published in the June issue of the Journal of Nursing Education, a series of seven learning activities were described that focused on development of evidence-based practice (EBP) and outcomes management knowledge and skills throughout an undergraduate nursing curriculum. These seven learning activities spiral in increased complexity while building on previously acquired skills. This Syllabus Selection presents the second and third sequential learning activities, which focus on continued development in database searching to answer clinical questions, evaluation of levels of evidence, increased proficiency in citation and referencing, beginning scholarly dissemination skills, and working as a team to fulfill commitments and assignments.

Essential competencies for the health care professional in the 21st century include knowledge about EBP, skill in informatics, and ability to work in an interdisciplinary health care team (Institute of Medicine, 2003). Two of seven learning activities designed to embed EBP and outcomes management content and skills throughout a program of study are presented in this article (Ross et al., 2009). These activities revisit and spiral foundational EBP skills presented in a previous course and provide beginning development of team-building skills and scholarly dissemination. A spiral curriculum framework intentionally revisits and builds on previously learned concepts and topics with increased complexity (Harden & Stamper, 1999). These learning activities occur in first-year Chronic Illness I and Acute Care I nursing courses. They are accompanied by rubrics to guide the students in the project and to be used for numeric grading.

Description of Learning Activity

The goals for this learning activity are for students to demonstrate:

  • Continuing development in online database searching to answer clinical questions.
  • Evaluation of levels of evidence.
  • Increased proficiency in using American Psychological Association style to reference multiple sources.
  • Beginning scholarly dissemination skills through a poster presentation.
  • The ability to work as a member of a team to fulfill commitments and assignments.

For both courses, students work in faculty-assigned teams to complete the assignment. The teams are designed based on a diversity of age, gender, ethnic background, and health care experience (Michaelsen, Bauman Knight, & Fink, 2004). For the Chronic Illness I nursing course, students are assigned a chronic illness for the term and investigate aspects of living with the disease, such as pathology, local and electronic resources for clients, and costs of the disease. The EBP component of this assignment is to identify what complementary and alternative therapies are used by people with the assigned disease. They select one of these therapies and search the literature to find scientific evidence that supports or refutes its effectiveness. References are cited. Students are provided with resources to help them prepare a professional poster.

A day at the end of the term is set aside to mimic a nursing research poster presentation in which posters are set up and students simultaneously present their poster to other students and course faculty. In the following Acute Care I nursing course, the assignment is to work in a team to develop a clinical question on an area of nursing interest to uncover best practices based on a format presented in an earlier course. In their poster presentation, they are asked to provide background and statistics as to the nature of the problem, a summary of the conclusions, and practice implications from the evidence evaluated. Their scholarly dissemination is spiraled to a poster presentation to the school of nursing community. As recommended by Stevens and Levi (2004), a grading rubric is used to guide completion of the assignment and includes the dimensions of evidence, knowledge, communication, visual presentation, and peer evaluation. A significant portion of the individual grade is peer-awarded points, by which the rest of the team assesses the contribution of the individual member (Michaelsen et al., 2004).

Student Response

Students and faculty are engaged in the poster presentations and particularly enjoy dialoguing about what they have learned. In addition, some have had the opportunity to participate and present their posters at other local conferences. Rarely, some teams or team members did not work well using this collaborative approach. In response, faculty added a midway team health check to identify and intervene with unhealthy groups earlier in the term. These assignments provide continued skill development in EBP and teamwork while introducing students to scholarly dissemination.


  • Harden, R.M., & Stamper, N. (1999). What is a spiral curriculum? Medical Teacher, 21, 141-143.
  • Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.
  • Michaelsen, L.K., Bauman Knight, A., & Fink, L.D. (Eds.). (2004). Team-based learning: A transformative use of small groups in college teaching. Sterling, VA: Stylus.
  • Ross, A.M., Noone, J., Luce, L.L., & Sideras, S.A. (2009). Spiraling evidence-based practice and outcomes management concepts in an undergraduate curriculum: A systematic approach. Journal of Nursing Education, 48, 319-326.
  • Stevens, D.D., & Levi, A.J. (2004). Introduction to rubrics: An assessment tool to save grading time, convey effective feedback and promote student learning. Sterling, VA: Stylus.

Joanne Noone, PhD, RN
Oregon Health & Science University



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