Journal of Nursing Education

Major Articles 

Collaborative Action Research: Implementation of Cooperative Learning

Marilyn Smith-Stoner, PhD, RN; Mary E. Molle, PhD, RN, PHCNS-BC


Nurse educators must continually improve their teaching skills through innovation. However, research about the process used by faculty members to transform their teaching methods is limited. This collaborative study uses classroom action research to describe, analyze, and address problems encountered in implementing cooperative learning in two undergraduate nursing courses. After four rounds of action and reflection, the following themes emerged: students did not understand the need for structured cooperative learning; classroom structure and seating arrangement influenced the effectiveness of activities; highly structured activities engaged the students; and short, targeted activities that involved novel content were most effective. These findings indicate that designing specific activities to prepare students for class is critical to cooperative learning.


Nurse educators must continually improve their teaching skills through innovation. However, research about the process used by faculty members to transform their teaching methods is limited. This collaborative study uses classroom action research to describe, analyze, and address problems encountered in implementing cooperative learning in two undergraduate nursing courses. After four rounds of action and reflection, the following themes emerged: students did not understand the need for structured cooperative learning; classroom structure and seating arrangement influenced the effectiveness of activities; highly structured activities engaged the students; and short, targeted activities that involved novel content were most effective. These findings indicate that designing specific activities to prepare students for class is critical to cooperative learning.

Dr. Smith-Stoner is Associate Professor of Nursing, and Dr. Molle is Professor, California State University San Bernardino, San Bernardino, California.

Dr. Molle was supported in part by NIH Research Infrastructure Grant #P20MD002722.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Marilyn Smith-Stoner, PhD, RN, Associate Professor of Nursing, California State University San Bernardino, HP 215, 5500 University Parkway, San Bernardino, CA 92407; e-mail:

Received: January 23, 2009
Accepted: August 10, 2009
Posted Online: June 03, 2010

Meeting the needs and desires of today’s students provides a continuing challenge to nurse educators. Some researchers report that innovative instructional methods using cooperative learning increase student satisfaction (Johnson, Johnson, & Stanne, 2000; Schell, 2006), and evidence suggests that these methods may be successful in engaging the younger generation of learners (Henry, 2006; McGlynn, 2005).

Diekelmann (2005) observes that to change their teaching methods, faculty members first need to transform themselves by learning—reading, asking questions, thinking, and listening (p. 485). However, little research has been done on the process that experienced educators use to retool their instructional style (Schell, 2006). We describe the results of our collaborative research project, which focused on the transformation of our instructional methods from what we call “sage on the stage,” in which students are passive learners, to “guide on the side,” in which students are actively engaged in learning throughout every class session. We present the insights we gained regarding the process of faculty transformation from four cycles of action and reflection. We include examples of successful discussion activities and suggestions for other educators.

Generational Differences

Recent studies describe the values and competencies of Generation Xers, born between 1960 and 1980 (Sacks, 1999; Twenge, 2007), and Millennials, born between 1981 and 2002 (Howe, Strauss, & Matson, 2000; Lancaster & Stillman, 2003), as different from those of the Baby Boom generation, who comprise the majority of nursing faculty. Qualities of Generation X students relevant to instructional strategies include a focus on outcomes rather than process, comfort with technology and multitasking, and self-orientation with a goal of having fun (Tulgan, 2006).

In their popular book, Millennials Rising, Strauss and Howe (2000) portray the current and upcoming generation of college students, the Millennials, as the most diverse generation ever. As students, they plan to study little but have high expectations for their instructors to meet their unique needs. Most Millennials have led sheltered, structured lives and are self-confident but need affirmation. They prefer teamwork to individual effort and creative, technology-based learning strategies to traditional teaching methods; they demand a voice in decision making; and they want to balance life and work (Strauss & Howe, 2000). Although Hoover (2007) warned against taking these generalizations too seriously and refuted some of Strauss and Howe’s findings, our experience indicates that Millennials do not respond well to traditional teaching methods. Consequently, nursing faculty must develop new, more effective methods for improving the performance of students who generally do not share their instructors’ preferences for learning strategies.

The National Survey of Student Engagement (NSSE) provides an annual update of experiences that enhance learning for current students. The most recent report emphasizes the inclusion of high-impact activities, such as creating a learning community, conducting research with faculty, studying abroad, and completing a culminating senior experience (NSSE, 2007). Our experience suggests that collaborative action research, in which instructors work together to examine their own educational practice systematically, can help nursing faculty develop new, more effective learning opportunities for Millennial students.

Classroom Action Research

Cross and Steadman (1996) defined classroom research as cumulative and ongoing inquiry about what affects student learning in the classroom. A variation of classroom research called classroom action research (CAR) involves inquiry and discussion of what promotes effective student learning (Baumfield, Hall, & Wall, 2008; Cross & Steadman, 1996; Kur, DePorres, & Westup, 2008; Macintyre, 2000; Ragland, 2006). Focusing on systematic inquiry by teachers in their own classrooms (Macintyre, 2000), CAR involves more than one researcher—in this case, two nursing instructors who teach in a state-supported undergraduate nursing department. Classroom action research is particularly appropriate as a method for faculty to develop new skills or to transform their existing instructional skills.

Cooperative Learning

After attending a 2-day faculty development workshop sponsored by the Teaching Resource Center at our university, we wanted to develop a method for systematically implementing cooperative learning. Cooperative learning is a collection of skills that involve curriculum planning, creativity, facilitation, and persistence (Johnson & Johnson, 1999). Cooperative learning is highly structured, with specific elements outlined in Table 1. Several faculty members thought that the implementation of structured cooperative learning activities would enhance the learning outcomes of the program and prepare students for working in groups once they graduated.

Principles of Cooperative Learning

Table 1: Principles of Cooperative Learning

In this first phase of instructional transformation, we worked through the basic skills we would need to implement cooperative learning fully, including classroom management techniques to shift the focus from the whole class to student-centered small groups and back to the whole class. We also needed to develop group learning skills and reduce the amount of content we presented through lectures, compared with group activities, that promote student thinking.

In planning instructional changes, we needed to address our students’ expectations, which we determined by conducting a survey during the first class. Besides expecting to do well while multitasking (e.g., listening to music, reading, instant messaging) and to be given help when they are not doing well (McGlynn, 2005), our students preferred having their instructors present a complete outline of course content on PowerPoint® slides rather than through traditional lectures and expected examinations to be derived directly from the PowerPoint presentations. Some students stated they no longer purchased any course-related books because they expected the instructor to synthesize important content during class, which would eliminate the need for purchasing a textbook. Students tended to evaluate instructors whose examinations did not closely match the content of lectures and prepared materials as “unorganized.”

We also talked repeatedly with our fellow nursing instructors to determine their concerns regarding teaching Millennials. These conversations highlighted the need to involve students more actively in their education, in particular, the need to motivate them to prepare for class. Our colleagues noted that class sizes have steadily increased (from 40 students to 80), leaving them with less time and fewer resources to manage instructional activities, such as grading assignments, preparing and presenting course materials in class, and updating course content.

Literature Review

To develop an integrated model that focused on adapting teaching methods to a new generation of students, we needed to understand the process of transforming teaching methods effectively. After a review of the literature on transforming instructional methods, we developed an eclectic model based on continuous dialogue (Lynn & Smith-Maddox, 2007), constructivism (Gilles & Ashman, 2003), and transformative learning (Mezirow, 1994). Our reflective model involved our continuous dialogue with each other and with our students, framed in constructivism and focused on transforming not only our thinking but also our students’ reactions to changes in our teaching methods.


The study was conducted at a rural state-funded university in Southern California. There are approximately 500 nursing students. The university is designated as a Hispanic-serving institution. Most classes are presented in a traditional format. Classroom action research begins with the identification of a problem and the development of a question relating to the classroom problem. We identified several interrelated problems, including over-large classes, too many failing students, and too many unprepared students. In response to these problems, we formulated the research question: In what ways can cooperative learning improve learning outcomes? The two researchers met four times throughout a 10-week period, following a standard CAR design in two different undergraduate nursing classes—an introductory medical and surgical course and a senior-level community health class. Reflections centered on two concepts—the effectiveness of cooperative learning and the challenges involved in introducing cooperative learning. The study was approved by the institutional review board. Consent was obtained by the two faculty conducting the research.


We met four times in the quarter to discuss the instructional strategies used. The sequence of working in the class and then discussing the experience formed the four action-reflection cycles used for the study. We recorded the reflection cycles using an audiorecorder and analyzed the action cycles for themes, applying the results of each action-reflection cycle to the next cycle. Our goal was to explore the successes and challenges of each step systematically. Before conducting the study, we developed specific course-related cooperative learning activities, which we modified as necessary during the experiment. Each activity included the five elements described by Johnson, Johnson, and Holubec (1990): positive interdependence (participation by all group members), promotion of interaction, individual accountability, interpersonal and small group skills, and group process.

After each 2-week period of action, we met to reflect on the successes and failures of our methods and to discuss the students’ reactions to the cooperative learning activities to determine the next step in the process. During reflection, we were able to describe our activities, frankly discuss the successes and failures, determine a revised approach, and support each other in the project. Prior to this project, instructional methods focused on the use of “sage on the stage” methods as lectures, PowerPoint presentations, and question-and-answer sessions periodically throughout the class period. Other activities were included periodically in a course, but they were not systematic. Of note, students preferred highly structured lectures and did not object to the instructional format.


This section describes the four cycles of action and reflection. Table 2 presents the research process and the results.

Process of Classroom Action Research

Table 2: Process of Classroom Action Research

Action-Reflection Cycle 1

Forming Groups. The initial cycle focused on organizing the class groups and on seating arrangements. In accordance with the literature, we deliberately assigned students to create groups, which fixed their seating arrangements, to ensure that each group had students of varying abilities (Gilles, 2007; Gilles & Ashman, 2003; Johnson & Johnson, 1999). One class used grade point averages, and the medical-surgical class used self-identified introverts and extroverts. We found arranging students by grade point average to be as effective as randomly assigning students to groups. For the medical-surgical class, we found that asking students to identify themselves as introverts, extroverts, or in between and then grouping them accordingly worked well because it led students to develop new skills. For example, in groups composed of extroverts, students learned new ways of listening and organizing. In groups of introverts, students were guaranteed opportunities to talk, which they might not have had otherwise.

Quiet Signal. During the faculty development workshop, the facilitator suggested using a graphic of a raised hand as a quiet signal (Kagan, 1994). Although the quiet signal worked effectively during the workshop, most students ignored it. Others verbally commented “We are not children!” After multiple discussions with students about the goals of a quiet signal, students still objected to the use of a quiet signal but understood the goal more clearly. Some of the classes decided that when the instructor raised her hand, students would signal others to be quiet.

Action-Reflection Cycle 2

Transitions Between Group and Individual Work. Because the transition from group work to whole-class discussions was crucial to the success of the experiment, the second action reflection cycle focused on managing time efficiently and ensuring that students knew what was expected of them in each activity. We displayed a timer using a projection device so that all students could see it. Limiting discussion periods to 10 or 15 minutes worked best to maintain students’ focus on the learning activity.

In the second reflection cycle, we focused on negative feedback from students. Several weeks into the quarter, students had begun to question the need for and appropriateness of collaborative class discussions. We identified the following themes in student resistance:

  • Many students did not prepare for class and consequently had few insights to contribute.
  • Students, in general, focused on acquiring the knowledge they needed to pass their examinations. They viewed any discussion beyond what they needed to know for the examinations as unnecessary and consequently contributed little to the additional discussion.
  • Not all cooperative learning activities resulted in the level of engagement necessary to produce critical thinking.

Action-Reflection Cycle 3

During the third action-reflection cycle, we continued to focus on the structure of the learning activities and made some adjustments. For example, we initially planned to provide the directions for group activities using overhead transparencies or written instructions on the board. However, we discovered that our students needed instructions printed on paper to focus their discussions within the group and to promote participation by all group members. As a result, we provided each group with one hard copy of instructions for each cooperative activity. We also wrote instructions on the chalkboard before class. Advance organizers, which gave students an overview of activities to come, were critical to students’ engagement.

Action-Reflection Cycle 4

During the fourth and final reflection cycle, we shared successes related to more dynamic cooperative learning activities. The Figure describes a successful cooperative learning activity related to death and dying that was used in the beginning medical-surgical course. This activity, which was first learned at the Zen Hospice in San Francisco, is commonly used by all kinds of educators.

Cooperative Learning Activity (Death Awareness).

Figure. Cooperative Learning Activity (Death Awareness).

The primary activity used in the community health class was intervention matching. In the traditional nursing education classroom, the instructor describes 17 public health interventions (i.e., broad, complex roles that the nurse would assume in public health) in a lecture followed by class discussion. Rather than presenting the interventions in a lecture format, the instructor directed students to prepare for class by studying the definitions. Mastering the definitions provided a break from the classroom lecture. After the instructor gave each student a card containing either an intervention or its definition, we met outside on a nearby lawn. Students had to find the person with the corresponding card within the specified time. Once the pairs were matched, students read aloud their matches and the group confirmed whether they were correct. We repeated the activity three times during the same class period, with increasingly shorter completion times. Students who participated in this activity mastered the names and definitions of the interventions more thoroughly than did students taught by traditional methods, as shown by their performance on subsequent examinations and their use of the terms during class. Having enough carefully matched terms and definitions is essential to the success of this activity. Instructors can easily see who has not prepared for class because those students tend to stand at the edge of the lawn waiting for another student to find them.


The results of our study support much of the literature on cooperative learning. For example, students did participate in activities that they found meaningful. We were not able to assess other measures of effectiveness, such as performance on examinations, that will be part of the next step in fully incorporating active learning. However, new concerns emerged.


The study succeeded in three ways. First, more direct involvement with students enabled us to identify students with learning difficulties early in the course and help them overcome barriers to their success in the program. Second, we could address students’ errors during class time, rather than waiting for a test to demonstrate their misunderstanding of course content. Finally, the instructors could serve as role models for collaboration by listening to student discussions, asking clarifying questions, acknowledging differences within a group, and clarifying errors in thinking.


Because students’ expectations provided a formidable barrier to moving through more sophisticated cooperative learning activities, the instructors spent much of the group time encouraging students to participate in discussions with each other, instead of raising their hands to ask questions. Their resistance may result, in part, from a failure to acquire “the skills, techniques, and behaviors for mastering the ‘hidden curriculum’ [Kegan, 2000, p. 45]” (Kerka, 2001, Beyond Life Skills section, ¶ 4), such as the ability to make meaning out of the material and activities in a classroom.

Another obstacle we encountered was that some students would not assume the responsibility of preparing for class, preferring to have instructors present material using PowerPoint slides. Several students voiced concern that instructors were not properly prepared for class, claiming that the students were “doing all the work.” When students do not participate in classroom activities, they miss a learning opportunity. We have increased our efforts to encourage students to prepare for class and participate in discussion. However, the collaboration process needs to be introduced slowly and continue throughout the curriculum. Ideally, the entire nursing faculty would participate in the process so that students could gradually build the skills of discussion, reflection, and cooperation in all nursing students.

One problem that we encountered, the effects of an unsuitable environment on group learning, is mentioned only briefly in the literature on cooperative learning. Stiles (2006) reported that cooperative learning can “be applied in various setting, such as classrooms [and] lecture halls” (p. 257). However, we discovered that not all classrooms are properly equipped for cooperative learning. One classroom in our experiment was actually a theater, which was being used as a classroom because not enough large classrooms were available to accommodate 80 students. Fixed theater seating and inadequate lighting in this “classroom” made writing difficult and restricted group interaction.

Implications for the Future

To develop the requisite skills of designing, implementing, and evaluating cooperative learning, faculty members need a systematic and collaborative process of implementation. We recommend consultations with other faculty members, nursing student leaders, and faculty developers. Cooperative learning must be integrated into the curriculum in a thoughtful manner. It is especially important to have faculty buy-in, as cooperative learning skills require practice. Techniques such as a quiet signal will work best when all faculty members use the same signal.

Cooperative learning requires courage and tenacity, especially during the initial period when students must develop new classroom behaviors. Designing specific activities to ensure that students are prepared for class is essential if cooperative learning is to result in complex thinking. In the future, students who come to class unprepared may be asked to leave and to complete necessary work before the next class.

Assigning students to groups based on their grade point averages creates balanced groups and enables the instructor to monitor the weaker students throughout the term. During classroom activities, the instructor can watch weaker students’ responses to gauge how well they are integrating material. However, many students resisted being assigned to particular groups, and instructors needed additional time to modify groups if some members were absent.

Facilitating critical thinking, probing comments for clarification, and creativity requires the instructor to demand that students go beyond basic concepts to deeper levels of synthesizing theory and clinical curriculum content. As we continue to transform our instructional styles, we will use the insight gained from this experience to increase the effectiveness of new approaches. Our next step is to integrate graded quizzes using audience-response systems or clickers that will require students to prepare prior to coming to class.

We will conduct additional classroom action research studies on how to incorporate laptop computers into a classroom, how to use text messaging between faculty and students effectively, and how to supplement in-class activities with Web-based multimedia. To transform ourselves, we must persist despite objections from students, including unfavorable teacher evaluations. To transform nursing education, we must first transform ourselves.


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Principles of Cooperative Learning

PrincipleSample In-Class Activity
Positive interdependence (students know that everyone must participate for the group to be successful)Students complete a focused-care plan as a group
Promotion of interaction (students interact face-to-face)Students collaborate on each activity or assignment
Individual accountability (each student must be prepared to work in a group)Students complete activity individually before class, often through specific homework assignment
Interpersonal and small-group skills (students learn to listen and ask clarifying questions)Instructor encourages students to discuss concepts and question others
Group process (students discuss how well the group achieved its goal)Students work on activity in preset groups; instructor allows time after completion to discuss successes and failures

Process of Classroom Action Research

Planning Stage
  Identify a problem or set of problems.Over-large classes with too many failing students, too many unprepared students, and some students overwhelmed by the amount of required reading.
  Pose a question about how faculty might solve the problem.In what ways can students be more actively involved in participating in the classroom?
  Determine your focus and objectives.Implement collaborative learning using strategies from faculty development workshop and research.
  Establish timeline for cycles of action and reflection.Four 2-week action cycles, each followed by a reflection cycle.
Cycle 1
  Action: Implement the change.Assign seats and groups to minimize socializing. Use prearranged quiet signal.
  Observations:Students perceived the quiet signal as childish and ignored it but did respond when instructor signaled for the class to stop talking. Students were more engaged when they did not know in advance who would be selected by the instructor to present the group’s findings.
Rooms, such as a theater, required more preparation and students need to move around more.
  Reflection: Focus on structure of the room and the class.
Cycle 2
  Action: Expand the use of cooperative learning strategies.Instructors should explain why cooperative learning is being implemented and how it will benefit students. Instructors must actively engage in discussing the concepts with students, walking around the class to listen and encourage student participation during cooperative learning activities. After the activity, the instructor should select students who have successfully demonstrated knowledge of the concepts to share their findings with the rest of the class. Inconsistent attendance made it more difficult to quickly identify students ready to present knowledge and insights to the class. Students were most involved in intense activities that engaged both their emotions and their minds. Sharing results with the whole class resulted in broader engagement.
  Reflection: The need for change to structured cooperative learning was not clear to students.
Cycle 3
  Action: Promote more positive interdependence in groups.Students preferred printed instructions, even if the activity did not involve writing.
  Although all activities were preplanned, students seemed to respond better to directions on paper than to directions displayed on a screen or written on the board.
  Reflection: The students stayed engaged when the activities were highly structured.
Cycle 4
  Action: Identify the most effective activities.
  Reflection: The most effective cooperative learning activities involved three key factors:

Were highly focused and brief (10 to 15 minutes).

Involved selected students presenting group work to the whole class.

Focused on an interesting patient-care problem that required a solution.


Dr. Smith-Stoner is Associate Professor of Nursing, and Dr. Molle is Professor, California State University San Bernardino, San Bernardino, California.

Dr. Molle was supported in part by NIH Research Infrastructure Grant #P20MD002722.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Marilyn Smith-Stoner, PhD, RN, Associate Professor of Nursing, California State University San Bernardino, HP 215, 5500 University Parkway, San Bernardino, CA 92407; e-mail:


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