Journal of Nursing Education

Educational Innovations 

Instructor-Created Activities to Engage Undergraduate Nursing Research Students

Linda L. Pierce, PhD, RN, CRRN, FAHA, FAAN; Kristina M. Reuille, PhD, RN

Abstract

Background:

In flipped or blended classrooms, instruction intentionally shifts to a student-centered model for a problem-based learning approach, where class time explores topics in greater depth, creating meaningful learning opportunities.

Method:

This article describes instructor-created activities focused on research processes linked to evidence-based practice that engage undergraduate nursing research students. In the classroom, these activities include individual and team work to foster critical thinking and stimulate student discussion of topic material.

Results:

Six activities for small and large student groups are related to quantitative, qualitative, and both research processes, as well as applying research evidence to practice. Positive student outcomes included quantitative success on assignments and robust student topic discussions, along with instructor-noted overall group engagement and interest.

Conclusion:

Using these activities can result in class time for the construction of meaning, rather than primarily information transmission. Instructors may adopt these activities to involve and stimulate students' critical thinking about research and evidence-based practice. [J Nurs Educ. 2018;57(3):174–177.]

Abstract

Background:

In flipped or blended classrooms, instruction intentionally shifts to a student-centered model for a problem-based learning approach, where class time explores topics in greater depth, creating meaningful learning opportunities.

Method:

This article describes instructor-created activities focused on research processes linked to evidence-based practice that engage undergraduate nursing research students. In the classroom, these activities include individual and team work to foster critical thinking and stimulate student discussion of topic material.

Results:

Six activities for small and large student groups are related to quantitative, qualitative, and both research processes, as well as applying research evidence to practice. Positive student outcomes included quantitative success on assignments and robust student topic discussions, along with instructor-noted overall group engagement and interest.

Conclusion:

Using these activities can result in class time for the construction of meaning, rather than primarily information transmission. Instructors may adopt these activities to involve and stimulate students' critical thinking about research and evidence-based practice. [J Nurs Educ. 2018;57(3):174–177.]

In a classic 1993 article “From Sage on the Stage to Guide on the Side,” Alison King stressed the importance of the use of class time for the construction of meaning (value or worth), rather than only information (facts) transmission. King's (1993) early work is an impetus for an inversion to allow classroom time for students engaged active learning, rather than traditional instructor's lecture of material.

The Guide Approach

In an inverted, flipped, or blended classroom, instruction intentionally shifts to a student-centered model in which class time explores topics in greater depth and creates more meaningful learning opportunities than in traditional teacher-centered classrooms. Content delivery may take a variety of forms. Short lectures or video lessons prepared by the instructor or third parties are used to deliver content, although collaborative discussions, digital research, and text readings may also be used (Abeysekera & Dawson, 2015; Ronchetti, 2010; Topp, 2011). This learning format also refines in-class activities. These activities may include discussions, debates, or team work that involves problem solving and critical thinking assisted by peers and the instructors to engage the student in the content (Bennett et al., 2013).

Activities for Flipping the Nursing Research Classroom

The purpose of this article is to share six instructor-created activities used in teaching undergraduate nursing research that increase student engagement in the topic under consideration. Activities were related to the research and evidence-based practice processes implemented in the classroom with students (N = 30 to 80) to build on prior readings and outside class assignments and were interspersed with 10- to 20-minute instructor-driven content lectures. The students, individually or with a team of peers, had opportunities to think critically, participate actively, and assume responsibility for discussion of topic information and, ultimately, their self-learning.

Demonstrating Randomization

Activity 1

Teams are important to conducting research as the process does not happen in a vacuum. Placing students in teams of three to five at the first-class meeting for course activities demonstrated and reinforced the concept of randomization. One strategy involved students (N = 80) and the use of crayons. The instructor brought a box of different colored crayons to the classroom. For these 80 students, five yellow, five red, five blue, five green, and so on until 16 different colors equal to 80 crayons were placed in the box. Sixteen papers naming the colors of the crayons were taped to walls of the classroom. Each student in the classroom chose one crayon randomly from the box and met his or her teammates by the paper naming their crayon color.

To further connect the students into cohesive units for course assignments, each research team created a team name of their choice (e.g., cartoon character, singer, sport team). Profanity, innuendos, street drugs, or alcohol-related content names were excluded. These research teams remained connected throughout the term for in-class activities and course assignments.

Outcome Reactions

Qualitative student feedback included that the activity was “fun in getting to meet other students…in choosing a team name and working together.” Throughout the term, students reported that while they “did not always agree with their mates” during discussions and debates about topics, they “listened to everyone's ideas and learned.” Overall, students remained actively engaged in the research team activities throughout the term. The instructor observed that amount of time taken to gather students into teams was minimal, even with larger class sizes, when the teams were introduced in this way. In addition, students' excitement and collaboration (student-to-student eye contact, asking and responding to each member's questions, positive feedback, and appropriate use of humor) were consistent reactions. In an evaluative question about what this crayon activity demonstrated, students (n = 74/74; 100%) chose the correct answer: random assignment to groups.

Other Exercises in Randomization

Activity 2

One website dedicated solely to the generation of items at random is http://www.random.org. This website can be used for several applications of randomization within the classroom setting with class sizes (N = 30 to 80). At the beginning of the term, each student was assigned a number from one to the number of students in the class. This randomized list was used to call on individuals and teams when discussing in-class activities. To further demonstrate random assignment to groups, the random.org website's integer set generator was used to construct sets of students for random assignment to intervention or control groups for fictitious studies. An example was an intervention to teach students the university fight song or alma mater. The research hypothesis was that students would learn more words to the chosen music led by a choir director rather than by friends. Generated sets were numbered, and the instructor indicated which set was the intervention group (meet with choir director once per week for 3 weeks to learn words) or control group (meet with friends once per week for 3 weeks to learn words). This activity was helpful in reinforcing the distinction of random sampling with random assignment to groups and other types of sampling (e.g., convenience) with random assignment to groups.

Outcome Reactions

Using the randomized list to ask for individual or research teams responses not only drew students into the discussions, but also encouraged ownership for topic materials. In the fight song study example, students actively chatted with one another within their assigned intervention or control groups asking who could remember the words to the song. Many of the students (in both groups) admitted that they “did not know the music” and laughed about it. More importantly, the students said that the activities helped them understand “more about random sampling methods” for quantitative research methods. Results from a multiple choice assessment question indicated that 100% of the students (n = 72) identified that this activity exhibited how groups in a fictitious research study can be randomly organized.

Discriminating Research from Nonresearch Sources

Activity 3

This activity was useful at the beginning of the term and provided initial exposure to PubMed® and CINAHL search result formats and different research and nonresearch literature formats, helping students to distinguish among them. With the help of the university librarian, the instructor identified eight to 12 one-page examples of published items that included primary and secondary research sources (e.g., CINAHL or PubMed search results for the first page of articles) and examples of items that were not research (e.g., editorials or popular web-sites such as WebMD® or HealthCentral®). The examples were compiled into a portable document format binder and placed on the course learning management system website for student access. Students then worked in their research teams to complete a grid identifying (a) whether each item was research, and if so, whether it was a primary or secondary source, and (b) what Polit's and Beck's (2018) level of evidence, from #1 systematic review of randomized controlled trials through #7 expert opinion of authorities, was demonstrated. Students were also asked to briefly describe why the item was, or was not, research. An additional column was provided for student comments. This activity can be done inside or outside the classroom, individually or within the research teams.

Outcome Reactions

Overall, this classroom activity indirectly introduced students to the range of publications and formats of research sources for evidence-based practice. When asked, the students reported they found the assignment “helpful” in exposing them to these different resources and the exercise was “enjoyable in learning from my team members.” The instructor found that students generally completed the grid successfully, rarely leaving blanks. Many students (n = 30/32; 94%) were successful in discerning whether publications were research or nonresearch sources during testing.

Applying the IMRaD Format

Activity 4

The instructor reviewed the components of a published article using Polit's and Beck's (2018) IMRaD format (title and abstract, introduction, method, results, and discussion) and references, followed by a 10- to 15-minute classroom lecture based on students' assigned readings. Using the instructor-selected research publications, each research team was assigned a research article, given a Read the Publication worksheet, and asked to identify the IMRaD components. The worksheet could be found online ahead of class time or distributed in class. Students completed the worksheet and identified the page number(s) that contain the IMRaD components for the assigned study. An example of an item in this worksheet was “The [example] for this study (search for number of participants and demographic data to describe the [example], i.e., gender; age range; specific population) is detected on: (a) Page 152; (b) Page 154; (c) Pages 152 and 154; (d) Pages 152, 154–155.” To determine the best answer, students must read beyond the abstract, examining the methods as well as the results to uncover the best answer. The instructor met with each team to provide clarification and give encouragement. The research team members were then asked to orally present their findings to the class. Each team placed their published research article on the document camera to allow everyone in the class to visually follow along and add to the discussion of the IMRaD components for that article. The instructor facilitated the flow of ideas, inserted discussion prompts about the title and abstract and references, and confirmed that correct answers related to the IMRaD content with rationale were given.

Outcome Reactions

After the completion of this exercise, students reported that exposure to research articles helped them to engage with the material in a helpful way, adding increased value to the activity. As students debated answers in their research team before presenting their work, students could be heard enthusiastically exclaiming “I get it!” The instructor found that students developed increased proficiency in reading, critiquing, and identifying research study components of research articles. Upon completion of an individual assignment composed of 25 multiple choice questions, students (n = 76 to 77) earned a median grade of C (76% to 84.9%) or better.

Using Role-Playing for the Informed Consent Process

Activity 5

For this activity, the instructor solicited examples of informed consents from other faculty members or used personal consents approved by the institutional review board. Two students were chosen for this activity: (a) the first student played the role of the potential participant and the instructor played the role of the investigator, and (b) the second student placed this informed consent form on the document camera, so the class could follow along on the screen as the role-play unfolded. In the role-play, the instructor investigator read through the informed consent while the potential participant–student answered the questions. The instructor also asked all students to identify the different pieces of information in the consent. At the end of the role-play, students were asked to debate strengths and areas for improvement in this informed consent process. The discussion also included the Health Insurance Portability and Accountability Act as it applied to informed consent: protection and confidential handling of protected health information, such as demographic data, (e.g., age and gender).

Outcome Reactions

Whether the study consent form applied to caregivers, nurses, or elders, students took on the identity of that participant and became an active participant by acting out the role. The student audience asked appropriate questions about the legalities and ethics of the study, such as (a) “what about participant's cognitive impairment and ability to sign a consent form,” (b) “risks or clinical benefits to participants,” and (c) “payment of participants.” Successful student learning was evidenced through a research critique assignment where 100% of the students (n = 77) were able to correctly identify ethical and legal concerns of a published research study—that is, whether the study was approved by an institutional review board or ethics committee, whether appropriate informed consent procedures were used with all participants, (if not, were the reasons valid and justifiable) and whether adequate steps were taken to safeguard participants' privacy.

Applying Evidence to Practice

Activity 6

Created to improve the student's understanding of evidence-based practice, this activity focused on asking clinically relevant questions, finding and interpreting the evidence, and applying this evidence to clinical practice. The instructor presented a prerecorded lecture lasting 20 to 60 minutes. Lectures were retrieved by searching the term prerecorded evidence-based practice lectures available on the Internet at YouTube National Institutes of Health, and local public broadcasting stations. Students viewed the prerecorded lecture before class time. In research team groups during class time, students discussed (a) how the information or intervention(s) in the video can be used in their nursing practice, giving specific examples, (b) what are potential challenges of applying these ideas to practice, and (c) what was most interesting about the prerecorded video lecture material. The instructor led a facilitated, critical discussion of these questions.

Outcome Reactions

Each lecture is different and so were students' reactions. For example, one online lecture centered on research completed with children and music therapy. Research teams met and discussed the merits of that evidence. In this example, 100% of the students (n = 80) voted that the most interesting aspect of the experiment was “how 2-year-old twins reacted differently to the same music.” Teams also discussed the benefits of music “to soothe a crying child during an invasive procedure” or “to celebrate a child's accomplishment such as finishing treatments.” In addition, students mentioned that “hospitals or physicians and nurse managers might not be agreeable to using music therapy.” This type of activity enables students to begin to assess, dialogue about, and critique clinical practice quality for patients served. The ease, availability, and substantive content of prerecorded evidence-based practice lectures were highly rated by the instructor.

Conclusion

These six activities in the flipped or blended classroom allow instruction to purposefully shift to a student-centered model for a problem-based learning approach. Students actively participated during class time, exploring topics in greater depth and experiencing more meaningful learning opportunities. The student learning outcomes are based on student self-assessment and instructor observation, as well as quantified objective and participative measures of change in student attentiveness, engagement, or learning. These outcome reactions support intentional and directed use of classroom activities expanding student active engagement. Overall, these activities moved the students out of their classroom seat and got them talking with and learning from one another under instructor guidance. Other instructors may use these activities to involve and stimulate their students' critical thinking about nursing research and applied evidence-based practice, helping to redesign the classroom. The activities are approaches to problem-based learning that have not yet been systematically tested but have applicability to other institutions or potential to stimulate investigation. Future outcome assessment might focus more deliberately on changes in students' knowledge using pre- and posttest results cross-tabulated with measures of students' participation using these activities.

References

  • Abeysekera, L. & Dawson, P. (2015). Motivation and cognitive load in the flipped classroom: Definition, rationale, and a call for research. Higher Education Research & Development, 34, 1–14. doi:10.1080/07294360.2014.934336 [CrossRef]
  • Bennett, B., Spencer, D., Bergmann, J., Cockrum, T., Musallam, R., Sams, A. & Overmyer, J. (2013). The flipped classroom manifest. The Daily RIFF. Retrieved from http://www.thedailyriff.com/articles/the-flipped-class-manifest-823.php
  • King, A. (1993). From sage on the stage to guide on the side. College Teaching, 41, 30–35. doi:10.1080/87567555.1993.9926781 [CrossRef]
  • Polit, D. & Beck, C. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  • Ronchetti, M. (2010). Using video lectures to make teaching more interactive. International Journal of Emerging Technologies in Learning, 5, 45–48.
  • Topp, G. (2011). Flipped classrooms take advantage of technology. USA Today. Retrieved from http://usatoday30.usatoday.com/news/education/story/2011-10-06/flipped-classrooms-virtual-teaching/50681482/1
Authors

Dr. Pierce is Professor, and Dr. Reuille is Assistant Professor, College of Nursing, University of Toledo, Toledo, Ohio.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Cheryl Gies, DNP, RN, CNP, Retired Associate Professor at the University of Toledo College of Nursing, and Betty Jones, PED, Associate Professor Emerita at the Indiana University-Purdue University Indianapolis (IUPUI) School of Physical Education and Tourism Management, for their critical reviews of this manuscript.

Address correspondence to Linda L. Pierce, PhD, RN, CRRN, FAHA, FAAN, Professor, College of Nursing, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43614; e-mail: l.pierce@utoledo.edu.

Received: September 06, 2017
Accepted: October 25, 2017

10.3928/01484834-20180221-10

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