Meaningful action to shape health policy as well as advocate for patients is a well-established goal of nursing. Nevertheless, this goal can be challenging in the current era that abounds with a wide array of news sources representing an equally wide array of political perspectives. Moreover, the variation in credibility among news sources can be perplexing to seasoned participants in politics, much less undergraduate nursing students.
This article describes an approach to addressing this challenge that engages active learning supported by an app, Slack. The approach translates and expands on a learning strategy successfully used to support a cohort of Canadian students' understanding of environmental policy through active learning (Sabin & Olive, 2018). This learning strategy has been applied successfully in an undergraduate nursing course focusing on health policy, politics, and civic engagement, and is offered for consideration and adoption by other nurse educators.
Students were first exposed to a media bias chart. This taxonomy differentiates sources of news along a y axis ranging from contains inaccurate, fabricated information, and nonsense damaging to public discourse to original fact reporting. Along the x axis, each media source is categorized in a block ranging from extreme left to extreme right (Ad Fontes Media, 2018). Because some students were not familiar with the concepts of political left and right, an explanation of the political spectrum was required.
Students then selected a news source to follow for the semester from selections prepared by faculty across all quadrants of the media bias chart. To create a playful approach to selection, a Yankee Swap method was used whereby students each selected a number and then in chronological order, students had the opportunity to choose a news source of their own or “steal” one from another student. In this manner, faculty could ensure that collectively, the sources monitored throughout the class spanned right/conservative media outlets and left/liberal outlets, as well as an array of veracity levels.
During the selection process, each news outlet was further detailed by course faculty. Students had the opportunity to offer a rationale to switch to a different source, and only one student voiced this intention. In other words, students seemed content with the news source they had randomly selected or acquired. They also were offered the opportunity to monitor non-U.S. or non-English speaking news sources. Ultimately, one student monitored a major French news outlet, another monitored Telemundo, a major U.S. Spanish language news source, and a third student monitored the British Broadcasting Service.
Students then were told about Slack, an app that frequently is used in work settings (Pham & Cook, 2018) and thus also provided students experience with this communication modality. Slack allows for private group postings among members; students and faculty can all see and respond to each other's posts, but no one outside the group can view or participate in the class conversation. Small group posts and responses, as well as private student-to-student and student-to-faculty interchanges also are supported by Slack.
Students were required to post at least once a week, sharing any health news or health policy news; in the absence of this, students could post about the major news of the week carried by their media source. These posts then were discussed face to face each week in class, with an emphasis on similarities and differences among news sources in content, tone, and theme. The centrality of civil discourse was emphasized and reinforced, with a guiding principle of generous listening, defined as reasonable people can look at the same information and come to very different conclusions.
Each face-to-face class opened with a discussion of the news of the week. These in-class discussions of Slack posts also opened exploration of contemporary policy initiatives in a non-partisan manner, with nonpartisan civil discourse being a goal of the class. Specifically, the aim was to assemble the facts on an issue, expose hyperbole and inaccurate representations, and create a climate in which students then could decide their stance for themselves. Course faculty strived for a stance of personal neutrality on issues, and when that was not possible because of their publications and presentations in a particular area, students were advised to scrutinize those ideas with a particularly critical eye.
Examples of topics that generated a great deal of interest among students included Medicare for All, anti-vaxxers and the winter 2019 measles outbreaks, legal tensions surrounding the individual mandate under the Patient Protection and Affordable Care Act of 2010, and gun control, to name a few. Gun control and immigration policy emerged as the most contentious issues. These tensions provided an opportunity to illustrate the nation's division on central issues and explore how these could be reconciled.
Finally, students were remarkably forgiving when a topic arose that the faculty were not expert in and thus ill-prepared to lead the class discussion, for example, issues related to the International Monetary Fund. This rarely happened because faculty were following the Slack posts and thus had the opportunity to review policy issues outside their expertise prior to class. However, when this did occur, faculty were forthcoming in their unfamiliarity with the details of the issue and asked students to do a quick review in either the current or next class. This approach was well-received by students and augmented the faculty's ongoing message that we are all always learners, most especially in the rapid-paced, complex world of health policy.
Students were asked to name their favorite and least favorite aspects of the course on an end-of-the semester questionnaire. Most of the students indicated they enjoyed the easily accessible Slack app and the flexibility to post whenever they deemed appropriate, within the weekly time constraint. Many students noted that they appreciated follow-up class discussions on Slack postings and reported that these discussions added richness and depth to their course. They also reported the Slack postings made the lectures more relevant and relatable. A few (4 of 29) students revealed they did not like the task of posting every week and found it cumbersome. They reported it was an added assignment that they did not always have time to complete due to their own extraneous reasons.
Students generally would post immediately on hearing or reading news that was of interest to them and that they deemed worthy of sharing with their peers and faculty, creating real-time civic awareness. Items frequently in the news and reported across sources were easily discerned as substantial, more universal, and “real.” For example, the anti-vax movement and worldwide measles outbreak was highlighted on many news sources, and students became actively aware of the problem. The app also allowed students to react or comment on each other's postings. For example, students could “like” a post that was particularly interesting to them or start a thread for more in-depth conversations. These responses also provided the original author rapid feedback because posts were visible and quickly acknowledged.
Students were easily able to achieve one of the course objectives, to critique emerging health policies and their representation on diverse forms of news media, using Slack. Slack provided an easy-to-follow platform for students to distinguish among the wide array of media sources and their attendant political orientations, then discern manifestations of this orientation. Students then could draw their own more informed interpretations, and thus being prepared, they were ready to contact a policymaker on a topic to support a second course objective of contributing to health-related civic actions as an informed citizen.
Students also were highly supportive of the policy analysis-before-advocacy approach, stating that in too many classes, they were “fed” the political persuasion of the faculty member. Instead, students became highly engaged in exploring policy details, how policy is made and modified, and governmental approaches for solutions to vexing problems. This may reflect a generational trend. A recent Pew Research Center report found that seven of 10 members of Generation Z, those born after 1997 who comprise the majority of today's college students, believe that government should do more to solve the nation's problems (Parker, Graf, & Igielnik, 2019).
This trial use of the Slack app resulted in the authors concluding that Slack is an innovative tool that encouraged students to stay abreast of the ever-changing learning environment emblematic of health policy. The inclusion of a free, easily accessible, and usable social media app engaged undergraduate students with health policy current events, controversies, and media contradictions. The app also was useful in aligning contemporary social media culture with students' daily habits and just-in-time active learning.
The students, through active learning, discerned that the media can skew delivery of the news based on the politics of the media source. They achieved a sort of independence in the knowledge that they need to be wary of where the news comes from and how this information can misrepresent facts. Moreover, the exercise illustrated that these misrepresentations occur in media sources aligned with both sides of the political aisle. At the same time, the exercises demonstrated there are many news sources with credible reporting, with some, again, spanning slightly right or left. The students developed the capacity to critique news with a discerning eye, and many were emboldened to take action. Given the ever-changing health policy landscape and predominance of health care in political campaigns, it is essential that nurses stay abreast of the current policy issues to effectively advocate for their patients, including systems redesigned to achieve that end.
The use of the Slack app in this course also can be tied to the ethical principle of nonmaleficence, that is, to do no harm. For example, the students were exposed to a wide array of contemporary issues including health care waste, the pervasiveness of medical error and health care harm, the lack of price transparency, and surprise billing, to name just a few. Slack provided a platform for safe sharing and facilitated discussion both within the app portal itself and in subsequent face-to-face discussion.
Nevertheless, there are lessons learned for next time. First, it is recommended that students explore news sources and the media bias chart before selecting a news source. This would ensure that the source is an appropriate fit for students, holds their interest, can be easily accessed, and optimally mitigate students' requests to switch sources during the semester. Second, access to Slack should be explored in a class early in the semester, as one student who did not post for the entire first half of the semester later cited technical difficulties as the reason.
Finally, we agree with Sabin and Olive (2018), who noted that “using collaborative social technologies such as Slack–which both replicates and integrates the online and social-media environments that students already inhabit–can assist faculty in meeting their pedagogical goals online” (p. 183). In addition, apps such as FlipGrid also support the inclusion of video and are worthy of exploration for classes in which formal oral communication skill enhancement is a goal. In summary, based on this experience, the authors conclude that faculty relating to students' learning and communication needs and preferences will increase the depth and quality of student learning, as well as both their own and students' course satisfaction.
- Ad Fontes Media. (2018). Media bias chart: Version 4.0. Retrieved from http://www.adfontesmedia.com/
- Parker, K., Graf, N. & Igielnik, R. (2019). Generation Z looks a lot like Millennials on key social issues. Pew Research Center. Retrieved from https://www.pewsocialtrends.org/2019/01/17/generation-z-looks-a-lot-like-millennials-on-key-social-and-political-issues/
- Pham, C. & Cook, C. (2018, September19). Should employers pick up Slack. Retrieved from https://www.shrm.org/resourcesandtools/legal-and-compliance/employmentlaw/pages/employers-slack.aspx
- Sabin, J. & Olive, A. (2018). Slack: Adopting social-networking platforms for active learning. Political Science & Politics, 51, 183–189.