Nursing education must be a robust vehicle for change for community health nursing (CHN) in undergraduate programs. Nurses with a broad range of CHN competencies will be needed to meet the demands of community-based care in the coming years (Community Health Nurses of Canada, 2011b, 2011a; Stanhope, Lancaster, Jakubec, & Pike-MacDonald, 2017). To support students in meeting the competencies for CHN in an undergraduate Bachelor of Science in Nursing program, an innovative teaching and learning opportunity for students was created. In the current educational environment where students crave more learning opportunities in acute care settings, CHN is usually not a high priority for students (Shalof, 2014). There is a need to develop innovative ways for undergraduate nursing students to understand community nursing. The theoretical foundation for the learning opportunity was based on the Canadian Association of Schools of Nursing's (2014) entry-to-practice public health nursing competencies for undergraduate nursing education. To meet the changing curricular demands around CHN, an experiential learning opportunity presented itself with the use of PechaKucha, meaning chit-chat in Japanese.
PowerPoint® presentations by students have been a mainstay in the classroom to develop their communication skills and integration of theory with classroom practice. However, there has been some concern about the use of PowerPoint, as expressed by Apple's Steve Jobs (Anderson & Williams, 2012):
One of the first thing Jobs did during the product review process was ban PowerPoints. I hate the way people use slide presentations instead of thinking.
Jobs later recalled (Anderson & Williams, 2015):
People would confront a problem by creating a presentation. I wanted them to engage, to hash things out at the table, rather than show a bunch of slides. People who know what they're talking about don't need PowerPoint.
Perhaps the issue was not the PowerPoint, but how it was used. PechaKucha is a form of PowerPoint that is structured and visual, so there is no direct reading off the slides. Described in the literature by Dytham and Klein (2003) as a presentation format generated by designers and architects to present their work visually, PechaKucha comprises a presentation of 20 slides, with each being shown for 20 seconds. Using little text and primarily graphics and pictures, presenters instead need to think creatively how to present their topics visually and speak to the slides (Anderson & Williams, 2012). Recently, PechaKucha has been used in various educational settings for presentations that are structured and focused, leading to greater depth of knowledge. Masters and Holland (2012) described PechaKucha as a way to rescue student presentations. Traditionally, students tend to read their PowerPoint slides, with the results being extended time limits and loss of focus. The use of PechaKucha might lead to consistent improvement in student presentations and more understanding of the content (Masters & Holland, 2012).
This educational initiative was based on Kolb's (1984) experiential learning theory (ELT), which provided a holistic model for the learning process. This multilinear model of adult development is consistent with what is known about how individuals naturally learn, grow, and develop (Kolb, 1984). The four stages of Kolb's experiential learning cycle can be applied to students' (a) concrete experience, (b) reflective observation, (c) abstract conceptualization of community, and (d) active experimentation of the community data. Kolb's ELT is a cycle of learning in which immediate or concrete experiences provide a basis for observations and reflections, which are then assimilated and distilled into abstract concepts that produce new implications for action that can be actively tested and create new experiences (Kolb, 1984). The Kolb conceptual model drove this learning activity, which brought community nursing to life and provided students with experiential learning opportunities for community assessment.
A total of 157 second-year undergraduate baccalaureate nursing students participated in this educational innovation. This initiative used a windshield and walkabout survey (WWS), which is an adaptation of the original windshield survey, a validated community assessment tool (Vollman, Anderson, & McFarlane, 2008). The survey was adapted and called a WWS to include a walking component around the community. A PechaKucha presentation followed the WWS to develop students' ability to think critically about their community assessment and present their findings in a creative visual manner. Ethical approval was obtained from the university's research ethics board before this study was undertaken.
WWS Laboratory Manual
One section in the WWS laboratory manual recorded community assessment data; another section recorded supporting data completed post-WWS. The survey required students to assess the community and quickly collect data to understand the geographical features of the community and “the location of agencies, services, businesses, and industries and location of possible areas of environmental concern through ‘sight, sense, and sound’” (Cassells, 2007, p. 91–104).
During the last week of class, students presented their WWS findings in a PechaKucha presentation format—that is, 20 PowerPoint slides being shown for 20 seconds each. The slides were then organized so research data and observations were displayed graphically and visually (Dytham & Klein, 2003). The students included many pictures taken on their WWS to portray elements of the community assessment.
Through the WWS and PechaKucha presentations, students were able to (a) engage in a thoughtful process of inquiry to develop their knowledge of CHN practice, (b) develop their confidence and ability to act in alignment with their nursing values, and (c) navigate the complexities of the contemporary community health care environment. Prior to conducting the WWS, the students were exposed to a variety of community health concepts in class. The students were given class time for the community assessment using the WWS laboratory manual. Following Kolb's (1984) ELT, students were actively involved in and exposed to the concrete experience of performing a community assessment.
Students were able to relate community health core elements to their WWS observations of physical environment, health and social services, economy, transportation, and recreation. Students supported their observations relevant to current population statistics and current literature to address key community issues for population health campaigns, such as substance abuse, gambling, and access to health services. Students completed the abstract conceptualization stage by relating these observations to community needs or issues that were broad and diverse. They included, but were not limited to, accessibility, environmental exposure, gambling, substance and alcohol abuse, lack of green spaces, youth recreation, sexually transmitted infections, and opioid addiction. This is evidenced in the student WWS photograph (Figure 1), which students took during the WWS and presented in their PechaKucha. Students were able to discuss and demonstrate application of the types of health promotion interventions and recommendations that could be used to address these community needs and issues.
Student walkabout survey photograph depicting evidence of drug paraphernalia and usage in poorer area of town.
The final stage of the students' experiential learning was active experimentation, which was achieved when they were able to take elements of the WWS activity and concrete experience, coupled with their reflective observations, and apply concepts of health promotion to develop a PechaKucha presentation for their peers. The PechaKucha included information about issues that affected the health of the overall community. This led students to further understand the issues and needs of the community by integrating active experiential learning with CHN knowledge. By presenting the PechaKucha to one another in class, students became actively involved in their learning in a multilinear model of learning in which community health was central. They acquired a more in-depth understanding of their community and its health needs. There was obvious excitement within the student groups of this experiential discovery. Kolb reflected (1984) that for learning to be useful, most individuals need to place it in a context relevant to them; otherwise, the learning might be forgotten quickly.
Evaluations of the community health assessment and PechaKucha presentations were completed by students following the learning activities. The evaluation included a Likert-type scale questionnaire around the learning experience, as well as open text boxes for comments about learning outcomes.
The quantitative findings from the questionnaire were analyzed using descriptive statistics (Figure 2). Results suggested that the learning experience was positive for the students. By actualizing Kolb's (1984) ELT, the students were able to link their observations of the community's needs and issues to the importance of enhanced health promotion and disease prevention activities. The students also gained an appreciation of the knowledge, skills, and roles of community nursing practice beyond the acute care setting.
Findings from the questionnaire. The results are the percentage of respondents to each of the questions.
Open-ended text boxes were offered at the end of the questionnaire that give students the opportunity to reflect on their learning experience. The questions focused on their perception of the integration and application of their learning. A qualitative thematic analysis using an adapted Colaizzi approach was conducted to identify main themes (Morrow, Rodriquez, & King, 2015). This included familiarization with the comments to form meaning and cluster ideas to develop themes around the students' learning experiences. The main themes of Better Understanding, Preparation, and Application for community nursing were identified. Students were able to link their observations of the community's needs and issues to the importance of enhanced health promotion and disease prevention activities. The students also gained a better appreciation of the knowledge, skills, and roles of nursing practice beyond the acute care setting in the community.
Understanding. One student commented that because of the WWS and the PechaKucha, the student was:
Better equipped to confine to learn how to do a proper community assessment...create a better understanding of my community and the specific health needs of the community in a hands-on way.
Other students reported being more aware of the influence of the determinants of health on the community.
Preparation. The ability to relate classroom theory to real-life needs and issues in the community enhanced the learning experience. This actualization of the experiential learning cycle of Kolb's (1984) ELT gave students the opportunity to link their observations of the community to the importance of enhanced health promotion and disease prevention activities. One student stated that her level of preparation allowed for greater community connections:
[I am] able to make more detailed observation regarding the physical, economic, and social constructs of a community and apply these to future health care practice, especially in terms of social determinant of heath…exploring the city…having the opportunity to work as member of a team.
Application. Another student commented on the connection between the classroom and the community:
Be more aware of the environmental, ethical, cultural and other influences that play a role in communities…ability to apply in-class experience to an actual community. I liked [that] the experience was more hands-on.
The student evaluations were saturated with comments about the positive experience of the experiential, hands-on learning:
- [I] realized how much I hadn't noticed about the area I was observing until actually completing the WWS…took a closer look at the communities…think more in-depth on what aspects can be improved.
- [I] have learned a great deal about community assessment…[and] hands-on learning.
- Physically walking around the community and observing the various needs with my own eyes…[I] understand the health of the community I live in.
- Actually observing the area and seeing what it was like from a ‘ground level’ perspective was interactive.
- [I] see in practice [i.e., real life] conditions of communities through eyes/community nursing lens.
The ability of nursing faculty to engage students is critical to their developing the competencies required for community nurses through active participation, as well as the aesthetics of the PechaKucha. Innovative teaching strategies are needed to support students in meeting undergraduate competencies for CHN. This is particularly imperative as students come to terms with CHN and their ability to apply the knowledge in innovative ways. This teaching strategy enhances the students' knowledge and prepares them for their community clinical experience. In addition, Kolb's (1984) ELT served as a holistic model of the learning process as a multilinear model of adult development and learning.
The WWS was an ideal format for combining experiential learning and applying the standards of practice. In addition, using the community assessment data from the WWS and preparing a presentation in the PechaKucha format enabled students to develop their application of knowledge. The experiential learning allowed the students to synthesize the concepts of CHN and its application through innovative ways. With this PechaKucha presentation format, students' understanding of content is statistically equivalent to the traditional PowerPoint format (Klentzin, Paladino, Johnston, & Devine, 2010). The visual PechaKucha format of the community assessment gave students an enhanced opportunity to develop their aesthetic ways of knowing (Chinn & Kramer, 2015; Doane & Varcoe, 2015).
One limitation of the study was the weather. Due to course time constraints, students had few options regarding completion of the WWS. Some students commented on ways in which inclement weather restricted the number of WWS assessments, such as fewer community members out walking in cold winter weather.
To be relevant, nursing education in community nursing needs to be transformed. Kolb's (1984) ELT provided an opportunity for transformation with a holistic model for innovative teaching and learning to meet undergraduate nursing competencies for CHN. Through the concrete experiences and reflective observations garnered by conducting the WWS, along with the abstract conceptualization and active experimentation of PechaKucha, students developed nursing competencies important to CHN. The implementation of meaningful learning strategies with presentation skills will benefit students throughout their career and is foundational to strong and effective pedagogy.
Of particular importance to nurse educators is the use of experiential learning in developing nursing competencies for CHN through active participation and engagement, as well as aesthetics. Nurse educators continue to be challenged to find community clinical placements and create innovative ways to apply theory to community practice to further research on the scholarship of teaching is needed to aid in the development of pedagogy to support transformational experiential learning in nursing education. Further longitudinal research is needed to follow students from classroom theory regarding clinical practice to postgraduation to assess long-term nursing competencies for CHN. The use of a WWS and PechaKucha as innovative teaching strategies facilitated the understanding and application of CHN concepts, skills, and competencies.
- Anderson, J.S. & Williams, S.K. (February, 2012). Pecha Kucha for lean and sticky presentations in business classes. (Working Paper Series 12–03). Flagstaff, AZ: Northern Arizona University. Retrieved from https://core.ac.uk/download/pdf/151422462.pdf
- Canadian Association of Schools of Nursing. (May, 2014). Entry-to-practice public health nursing competencies for undergraduate nursing education. Retrieved from https://casn.ca/wp-content/uploads/2014/12/FINALpublichealthcompeENforweb.pdf
- Cassells, H. (2007). Community assessment. In Nies, M.A. & McEwen, M. (Eds.), Community/public health nursing: Promoting the health of populations (4th ed., pp. 91–104). Philadelphia, PA: Elsevier Saunders.
- Chinn, P.L. & Kramer, M.K. (2015). Knowledge development in nursing: Theory and process (9th ed.). St. Louis, MO: Elsevier Mosby.
- Community Health Nurses of Canada. (2011a). A blueprint for action for community health nursing in Canada. Toronto, ON: Community Health Nurses of Canada.
- Community Health Nurses of Canada. (2011b). Canadian community health nursing: Professional practice model and standards of practice. Toronto, ON: Community Health Nurses of Canada.
- Doane, G.H. & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing heath and health care context. Philadelphia, PA: Lippincott Williams & Wilkins.
- Dytham, M. & Klein, A. (2003). Pecha Kucha. Retrieved from http://www.klein-dytham.com/
- Klentzin, J.C., Paladino, E.B., Johnston, B. & Devine, C. (2010). Pecha Kucha: Using “lightning talk” in university instruction. Reference Services Review, 38, 158–167. doi:10.1108/00907321011020798 [CrossRef]
- Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development (1st ed.). Upper Saddle River, NJ: Prentice Hall.
- Masters, J.C. & Holland, B.E. (2012). Rescuing the student presentation with PechaKucha. Journal of Nursing Education, 51, 536. doi:10.3928/01484834-20120822-02 [CrossRef]
- Morrow, R., Rodriguez, A. & King, N. (2015). Colaizzi's descriptive phenomenological method. The Psychologist, 28, 643–644.
- Shalof, T. (with Shamian, J.). (2014). Bringing it home: A nurse discovers health care beyond the hospital. Toronto, ON: McCLelland & Stewart.
- Stanhope, M., Lancaster, J., Jakubec, S.L. & Pike-MacDonald, S.A. (2017). Community health nursing in Canada (3rd ed.). Milton, ON: Elsevier Canada.
- Vollman, A.R., Anderson, E.T. & McFarlane, J. (2008). Canadian community as partner: Theory and multidisciplinary practice in nursing (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.