In the United States, one approach that is not often referred to in the literature on teaching research to undergraduate nursing students is action research. Also referred to as participatory action research, social action research, community-based research, or emancipatory research, it is rarely, if ever, mentioned in textbooks on nursing research (Brown, 2009; Fawcett & Garity, 2009; Houser, 2008; LoBiondo-Wood & Haber, 2010; Norwood, 2010; Schmidt & Brown, 2009). If it is mentioned, it may appear in only one line or, at most, one paragraph (Fawcett & Garrity, 2009; Norwood, 2010). Because action research is not described in the hierarchy of levels of evidence, one could surmise that it may be why this type of research is lacking in nursing textbooks. The beginning of action research is attributed to the work of Kurt Lewin over 50 years ago (Small & Uttal, 1995). No specific methodology or definition exists, hence the many different terms mentioned above. More important than methodology (a variety of methods can be used), philosophy or purpose is most significant, rendering action research unique when compared with traditionally accepted types of research. Rapoport (1970) defined action research as aimed at “contributing both to the practical concerns of people in an immediate problematic situation and to the goals of social science by joint collaboration within a mutually acceptable ethical framework” (p. 499). In other words, action research is designed not only to contribute to the body of knowledge but also to collaborate with communities to find solutions to practical problems.
In 1993, Holter and Schwartz-Barcott reported that during the prior 10 years there had been an increasing interest in action research as a method that could help close the theory–research–practice gap in nursing. Since then, the use of action research has been growing in popularity as part of an evolving body of critical science in nursing, especially in the United Kingdom, Canada, and Australia (Dickinson, Welch, & Ager, 2007; Fontana, 2004; Glasson, Chang, & Bidewell, 2008; Li et al., 2010). For undergraduate students, learning about action research can be somewhat confusing because it can be described as both a method and a methodology. Regardless, the aims are essentially threefold: research, education, and linking practice to theory (Holter & Schwartz-Barcott, 1993). Alternatively, it has been described as a threefold process linking research, education, and policy development. However it is described, the purpose is to create change for the betterment of a community or an organization. What makes action research different from a more traditional research approach is that the intent of creating change is included as part of the project from the beginning. As described by Small and Uttal (2005), action research is not value free, and the methods are flexible, which may make more traditional nurse researchers and professors uncomfortable. On the other hand, because change may be evident earlier than with traditional research, it may appear more attractive or relevant to the learning style of millennial students.
It is safe to assume that most nursing professors who teach undergraduate research courses are keenly aware of the challenges that are associated with making this content come alive for students. As such, a variety of teaching strategies and pedagogies have been described by numerous authors. For example, Rash (2005) discussed incorporating a service-learning project with an honors research course. This experience proved to be interesting and exciting for students who continued to work on their projects even after completing the course. According to the author, the students’ engagement with community partners helped to make nursing research meaningful and concrete. Another teaching strategy incorporated evidence-based practice in research courses (Meeker, Jones, & Flanagan, 2008). In this example, the authors organized the course around the hierarchy of levels of evidence. Throughout the course, students learned how to identify and critique studies based on these levels. August-Brady (2005) implemented an innovative approach to teaching a course by incorporating a weekly 8-hour clinical component in which the students conducted a research project on a clinical unit. At the end of the course, students indicated that they had improved their critical thinking skills and had begun to see the value of nursing research.
As someone who spent many years conducting social action research with Latina victims of domestic violence, I spend some time in my class using examples of how my own research was used to change public policy, create a nonprofit organization, and organize women’s groups around the country (Rodriguez, 1999; Short & Rodriguez, 2002). I noticed that when I talked about my work, students’ interest and engagement were sparked by these examples, which is when I decided to redesign the course based on this method.
Redesigning the Course
The study by McCurry and Martins (2010) comparing traditional and innovative strategies for millennial learners serves as the backdrop for my own experience teaching a required undergraduate nursing research course in a small private college in the midwestern United States. Beginning in 2007, I taught the course using traditional teaching methods, such as lecture, discussion, critique of published research, and individual examinations. At this point, I had sequenced the course to teach quantitative and qualitative methods, with one class on action research toward the end of the semester. The rationale behind this decision was that students would better understand action research after they learned the basics, such as methodology, terminology, and statistics. The problem was that by the time I began using my own action research examples, I had lost the students’ attention (i.e., they were skipping class, not paying attention, and generally uninterested with the content). Although the action research content sparked some interest, it occurred only for the short time I discussed this content. After two semesters and abysmal evaluations, the urgency to redesign the course could not have been more apparent.
In spring 2009, I taught the first iteration of the new version of the course, starting with action research. Students were engaged and interested from the beginning. Some even commented informally that this approach made research more “real” and “understandable”; it began to “make sense” to them. To maintain this current of enthusiasm, I asked the class (40 students) to design a research project that would be conducted on campus. The project was not graded, but instead was used throughout the semester as a teaching tool, with the results presented at our campus’ annual Student Research Conference in April 2009.
Because the college is one of liberal arts with many different majors, I explained to the students that they would be able to use the results of their research to offer health promotion information throughout the campus and, as a result, make a contribution to improving the health of their community. As they had already learned, action research has three foci: education, research, and linking practice to theory (or policy development). The results of their research could provide health education information, as well as potentially be used to make policy recommendations on campus. Sharing examples of my own work helped students to see that this was a realistic possibility.
The project began by conducting observations of student behaviors around campus. During one class period, students were sent out in small groups to five different areas of the campus to document any behaviors they identified as unhealthy. To my surprise, after only an hour they came back to class with a list of 15 different behaviors they thought posed a health risk to their fellow students (i.e., their community). Some examples included texting while walking, students with excessively loud music emanating from headphones, making unhealthy food choices in the cafeteria, not using crosswalks, carrying heavy backpacks, and wearing “inappropriate footwear” (it was winter). Back in the classroom, we began the process of prioritizing the problems on their list. After three rounds, the students came to consensus that they would focus their project on the use of heavy backpacks. Based on this, the class then came to consensus on the final research question.
Each week, students learned a different aspect of the research process that coincided with their ongoing project. For example, after completing the required National Institutes of Health online course on ethics in research, each student was required to bring his or her certificate of completion to class to be submitted with their campus institutional review board (IRB) approval forms (without this, the student could not participate in the research project). As the course professor, I was required to complete and sign the forms. I used the completed IRB forms in class as an example to coincide with the topic on ethics in research. The next steps were to conduct a literature review and design the survey to gather information about health behaviors and consequences related to the use of backpacks. The students decided that it was important to weigh each backpack to compare respondents’ perception of the weight of their backpacks with the actual weight. The survey was targeted to students on campus and included questions about the use of backpacks (e.g., using one strap or two) and if he or she had experienced back, shoulder, or arm pain (action research education focus). It also included demographic information, such as college level (e.g., freshman, sophomore), major, age, and other relevant information. The final question on the survey allowed the respondent to make any recommendations regarding how the college could help address the issue of student backpack use (action research policy change focus).
Data collection occurred on two different days and two different class times (a 3-hour block). All students in the class were required to participate in data collection and were assigned to one of five groups situated in different areas on campus. As students approached these areas, the nursing students asked if he or she would participate in the study, thereby making this a convenience sample. Before beginning the survey, study participants had to read the consent form. Because the study had been approved by the campus Human Subjects Committee as exempt, agreeing to participate then fulfilled the requirement for informed consent. After the participants completed the survey, they were asked if their backpack could be weighed. The students in the class learned that one limitation of the study was that the scales were not all calibrated in the same manner, as they were using scales from home. Despite this limitation, it was a good learning experience because the course students understood the importance of different methods of data collection when conducting a research study. This was also a good example for teaching on the importance of reliability and validity.
After a guest lecture on how to use SPSS for data analysis, the class worked on creating the database. Each student was responsible for entering at least five questionnaires into the database by a certain deadline to be able to analyze the data during class. Descriptive statistics were taught using the database of questionnaires (N = 220) as the example. The students had a deadline to complete the data analysis because the research conference was scheduled during the end of April. Upon completion of the data analysis, the class then identified the limitations, implications, and recommendations.
Four students volunteered to represent the class at the campus research conference to present their research results. As part of their preparation, they performed a dry run in class, and the remaining students provided constructive criticism and proposed changes.
To complete the course, students learned about another method of dissemination of research results by designing scientific posters based on the results of the project. Because this occurred on the last day of class, the students were not able to present them to an audience. Instead, they hung them in the hallways of the nursing school.
Because the project took the entire semester to complete, these students were not able to create any educational materials to reinforce their learning about action research. Instead, senior-level students in the Community Health Nursing course were given the data the following semester and, as an extra-credit project, created brochures that could be disseminated throughout campus. Because I teach both the research course and the Community Health course, I was able to connect the two classes.
Since then, two more classes have conducted on-campus research projects using the same strategy. One class studied caffeine use (survey participants N = 316) and another studied sleep habits (survey participants N = 161). Students again presented their research at the campus Student Research Conference (April 2010). As of the spring 2011 semester, I have incorporated the results of these research projects into a health promotion assignment for students in the public health nursing class. Because students go through the program as a cohort, they are now (1 year later) able to use their research study as one of the health promotion topics. We plan to collaborate with the nurse from the campus health center to develop materials for the campus e-health magazine. In addition, students from the previous research classes have identified several areas for potential policy change based on their investigations of health risks on campus (i.e., options to decrease the need for backpacks, use of hand sanitizers at public computer terminals in the library, and healthier food choices in the campus cafeterias). These ideas will be incorporated into future assignments.
After redesigning the course, student evaluations improved considerably (i.e., improved twofold based on quantitative evaluation). Students also made more positive comments, such as: “I liked the fact that the class did a research project where all the ‘steps’ were followed. This is much more helpful than just learning or reading or talking about how to conduct a basic study.” Other comments included: “She provided us with a great learning experience with doing the research project that I think really helped us get engaged and interested in the material.”
One of the challenges in conducting a semester-long research project is ensuring that different research methods are covered in the course. Although the students did not comment about this, I worried they might become confused while they worked on their quantitative research project as they also needed to learn about qualitative methods. To address this, I redesigned the sequence to address qualitative methods first, and then focused on the quantitative content to coincide with the creation of the project survey.
Another challenge to consider is the size of the class, which in my case is generally 36 to 42 students. It is important to make sure that all students participate in each phase of the project. To this end, I incorporated several strategies. First, to promote inclusion of all students, consensus was used to prioritize the topic and the research question. Second, having the presenters perform a rehearsal of their presentation allowed for all students to make comments and recommendations regarding the research conference presentation. Finally, I asked students to sign in or turn in worksheets (or both) during each phase of the project to ensure their participation.
Although this was a fairly large group (N = 40), the students learned how to identify a research problem and move through the steps of the research process using action research. During this process, they learned about the importance of reaching consensus and working as a team. Finally, incorporating an action research focus helped students to realize that nursing research can be used to promote positive health behavior changes within their campus community.
- August-Brady, M. (2005). Teaching undergraduate research from a process perspective. Journal of Nursing Education, 44, 519–521.
- Brown, S. (2009). Evidence-based nursing: The research-practice connection. Sudbury, MA: Jones and Bartlett.
- Dickinson, A., Welch, C. & Ager, L. (2007). No longer hungry in hospital: Improving the hospital mealtime experience for older people through action research. Journal of Clinical Nursing, 17, 1492–1502. doi:10.1111/j.1365-2702.2007.02063.x [CrossRef]
- Fawcett, J. & Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F.A. Davis.
- Fontana, J. (2004). A methodology for critical science in nursing. Advances in Nursing Science, 27, 93–101.
- Glasson, J., Chang, E. & Bidewell, J. (2008). The value of participatory action research in clinical nursing practice. International Journal of Nursing Practice, 14, 34–39. doi:10.1111/j.1440-172X.2007.00665.x [CrossRef]
- Holter, I. & Schwartz-Barcott, D. (1993). Action research: What is it? How has it been used and how can it be used in nursing?Journal of Advanced Nursing, 18, 298–304. doi:10.1046/j.1365-2648.1993.18020298.x [CrossRef]
- Houser, J. (2008). Nursing research: Reading, using, and creating evidence. Sudbury, MA: Jones and Bartlett.
- Li, P., Bashford, L., Schwager, G., Spain, R., Ryan, H., Oakman, M. & Higgins, I., … (2010). Clinicians experiences of participating in an action research study. Contemporary Nurse, 35, 147–156. doi:10.5172/conu.2010.35.2.147 [CrossRef]
- LoBiondo-Wood, G. & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice. St. Louis, MO: Mosby.
- McMurry, M. & Martins, D. (2010). Teaching undergraduate nursing research: A comparison of traditional and innovative approaches for success with millennial learners. Journal of Nursing Education, 49, 276–279. doi:10.3928/01484834-20091217-02 [CrossRef]
- Meeker, A., Jones, J. & Flanagan, N. (2008). Teaching undergraduate nursing research from an evidence-based practice perspective. Journal of Nursing Education, 47, 376–379. doi:10.3928/01484834-20080801-06 [CrossRef]
- Norwood, S. (2010). Research essentials: Foundations for evidence-based practice. Upper Saddle River, NJ: Pearson.
- Rapoport, R. (1970). Three dilemmas in action research. Human Relations, 23, 499–513. doi:10.1177/001872677002300601 [CrossRef]
- Rash, E. (2005). A service learning research methods course. Journal of Nursing Education, 44, 477–478.
- Rodriguez, R. (1999). The power of the collective: Battered migrant farm-worker women creating safe spaces. Health Care for Women International, 20, 417–426. doi:10.1080/073993399245692 [CrossRef]
- Schmidt, N. & Brown, J. (2009). Evidence-based practice. Appraisal and application of research. Sudbury, MA: Jones and Bartlett.
- Short, L. & Rodriguez, R. (2002). Testing an intimate partner violence assessment icon form with battered migrant and seasonal farmworker women. Women & Health, 35, 181–192. doi:10.1300/J013v35n02_12 [CrossRef]
- Small, S. & Uttal, L. (2005). Action-oriented research: Strategies for engaged scholarship. Journal of Marriage and Family, 67, 936–948. doi:10.1111/j.1741-3737.2005.00185.x [CrossRef]