Journal of Nursing Education

Major Article 

Critical Incident Videos: Developing a Cognitive Strategy in Simulation for Faculty Development

Cynthia S. Randall, DNP, RN, CNL, CHSE; Carla E. Randall, PhD, RN, CNE

Abstract

Background:

Despite recommendations put forth by the National League for Nursing to incorporate a scope of practice and develop core competencies for nurse educators, nursing education is experiencing the effects of a faculty shortage. Many schools of nursing find it necessary to hire faculty members who have limited preparation as educators. The purpose of this study was to develop critical incident videos (CIVs) and evaluate how CIVs captured common teaching challenges.

Method:

This mixed-methods study used a participatory action research approach and involved three parts: an online survey, development of CIVs, and focus groups.

Results:

The survey captured challenging teaching situations that were operationalized for development of 10 CIVs. Using CIVs in focus groups revealed six key themes: Role Clarification, Isolation, Teaching Communication, Teaching Learning to Learn, Teacher Development, and Usefulness.

Conclusion:

CIVs were successful in capturing realistic teaching challenges and created opportunities for participants to use cognitive rehearsal, in the form of role-playing, to respond to these challenges. [J Nurs Educ. 2021;60(2):81–89.]

Abstract

Background:

Despite recommendations put forth by the National League for Nursing to incorporate a scope of practice and develop core competencies for nurse educators, nursing education is experiencing the effects of a faculty shortage. Many schools of nursing find it necessary to hire faculty members who have limited preparation as educators. The purpose of this study was to develop critical incident videos (CIVs) and evaluate how CIVs captured common teaching challenges.

Method:

This mixed-methods study used a participatory action research approach and involved three parts: an online survey, development of CIVs, and focus groups.

Results:

The survey captured challenging teaching situations that were operationalized for development of 10 CIVs. Using CIVs in focus groups revealed six key themes: Role Clarification, Isolation, Teaching Communication, Teaching Learning to Learn, Teacher Development, and Usefulness.

Conclusion:

CIVs were successful in capturing realistic teaching challenges and created opportunities for participants to use cognitive rehearsal, in the form of role-playing, to respond to these challenges. [J Nurs Educ. 2021;60(2):81–89.]

Nursing education is experiencing the consequence of a national faculty shortage. Hiring faculty members who are likely inexperienced as nurse educators further complicates the problem. This is a crucial time within nursing education that requires urgent attention.

The ability to educate future nurses rests on having nursing faculty who meet core educational competencies for teaching (Christensen & Simmons, 2020). With a marked decline over the past two decades of nurses entering advanced nursing education programs, there has been limited emphasis within the profession on developing nurse educators (National League for Nursing [NLN], 2014; NLN Board of Governors, 2002). According to Booth et al. (2016), to “serve effectively in the role of nurse educator, nurses need pedagogical preparation in curriculum development, teaching strategies, and evaluation methods” (p. 54). To meet the national competencies in nursing education, there is an immediate need to address the preparation and quality of nurse educators.

Strong recommendations for nurse educators put forth by the NLN (Christensen & Simmons, 2020) incorporate the scope of practice for teaching and address core competencies for educators. Despite emergent and ongoing recommendations to prepare nurse educators for advanced practice roles in teaching (Benner et al., 2010; NLN, 2011; NLN Board of Governors, 2002), nursing education has focused on preparing nurses for advanced practice roles in clinical specialties (Oermann 2017; Schoening, 2013). Many nurses who are hired in academia are not prepared for their role as faculty as “clinical expertise does not naturally result in teaching expertise” (Booth et al., 2016, p. 55). According to Oermann (2017), “many nurse faculty continue to gain their knowledge and competencies for teaching ‘on the job’” (p. 1).

A way to address this crucial time within nursing education is to focus on developing faculty members as educators. By creating cognitive learning opportunities in a simulated environment, faculty members can engage with teaching challenges they are likely to experience. The purpose of this project was to develop critical incident videos (CIVs) and evaluate how CIVs captured common teaching challenges.

Literature Review

Shortage of Faculty and Qualified Faculty Prepared to Teach

The NLN Board of Governors (2002) reported that during the 1990s, only 4% of nurses enrolled in graduate programs were pursuing Master of Nursing Education degrees. This limited enrollment has contributed to the nursing faculty shortage of the 21st century. Other critical factors associated with the shortage of full-time faculty members include recruitment challenges, trends in hiring part-time teachers, and low faculty salaries (NLN, 2014).

The American Association of Colleges of Nursing (AACN) reports annual increases in nursing faculty vacancies (AACN, 2019; Fang & Htut, 2008; Keyt et al., 2019). As of 2017, faculty vacancies reached nearly 2,000 nationwide, with one third of current nursing faculty members expected to retire by 2025 (Fang & Kesten, 2017). Hiring part-time faculty has become critical in satisfying the unmet needs of nursing programs facing a full-time nursing faculty shortage (McPherson, 2019; Santisteban & Egues, 2014). To meet the critical demand for faculty, some schools of nursing (SONs) hire Bachelor of Science in Nursing–prepared nurses as part-time faculty (Mangan, 2011; NLN, 2017; Woodworth, 2017). Therefore, the combination of these factors has resulted in the hiring of nurses who are underqualified and unprepared to teach in clinical or didactic settings.

Unprepared for Teaching: Pedagogical Preparation

Historically, SONs have hired clinically competent nurses to fill teaching vacancies. Although expert clinicians are often recruited into faculty teaching positions, many lack the preparation, recommended or required knowledge, and skills to be successful as educators (Gaberson et al., 2015; Schoening, 2013; Sorrell & Cangelosi, 2015). Suplee et al. (2014) reported similar findings and noted a trend to use “personal experiences as clinicians and students in constructing their roles” (p. S38). Krautscheid et al. (2008) reported that orientation to the role of clinical instructor focused on the “running of clinical rather than on teaching and learning” (p. 431), which leads educators to teach as they were taught (Diekelmann & Diekelmann, 2009). Bartels (2007) concluded that without teaching preparation and education, the understanding of nursing practice alone is an insufficient foundation for effective teaching.

According to the AACN (2006) and the NLN Board of Governors (2013), the basic doctoral curriculum does not prepare graduates for a faculty teaching role. The Doctor of Nursing Practice and PhD degrees do not adequately prepare nurse educators as evidenced by the lack of required education courses within these programs of study (Booth et al., 2016; Oermann, 2017). Schoening (2013) recommended that all nursing graduate programs include teacher education courses and experiential learning strategies to prepare nursing faculty members.

Although there are strong recommendations to recognize nursing education as a specialty area of practice and to include a standard for pedagogical preparation of nursing education (Benner et al., 2010; NLN, 2011), there is a paucity of published research addressing the developmental needs of nursing faculty (Oermann, 2017; Sorrell & Cangelosi, 2015). Therefore, it is paramount to formalize a process to address the learning needs of nursing faculty.

Theoretical Underpinnings

Cognitive Learning Strategy

This research study is grounded in cognitive learning theories. Cognition is the mental process of obtaining and using knowledge to understand one's thoughts and experiences (Cambridge Cognition, 2015). Cognitive load is the amount of information available to process a situation (Sweller, 1988). Limiting cognitive load maximizes the ability of the learner to process and respond to situational challenges, thereby increasing learning and memory (van Merriënboer & Sweller, 2010). An understanding of cognitive load and its effect on learning provides a framework for using simulation as a teaching strategy (Josephsen, 2015).

According to Griffin (2004), “A strategy that conceptually employs the use of cognition and automatic thoughts is cognitive rehearsal” (p. 259). Griffin and Clark (2014) identified cognitive rehearsal as a process that uses didactic knowledge and rehearsed learner responses as key elements in addressing challenging situations. Cognitive rehearsal, in the form of role-playing, creates a space for learners to formulate and practice responses.

Simulation and Role-Playing

Jeffries (2012) described role-playing as an interactive learning activity that mimics real situations. These simulations allow for deliberate practice of critical thinking, decision making, problem solving, and debriefing that help students to learn (Jeffries, 2012). According to Bhattacharjee (2014), role-playing enacts the process of thinking and use of knowledge while eliciting visceral responses, thereby making it grounded, and increases the efficacy of the learning experience. Role-playing, with debriefing, provides time for rethinking responses, decreases anxiety, and maximizes learning (Khiri & Mohammadi, 2016; Martinez et al., 2010).

Method

This study used a participatory action research (PAR) approach as defined by Polit and Beck (2017). The purpose of PAR is to have participants play a role in the research, resulting in “consciousness raising” and empowerment of people “through the process of constructing and using knowledge” (Polit & Beck, 2017, p. 482). Thus, an outcome of PAR is to make improvements through education and action (Polit & Beck, 2017).

The study was designed to have participants share examples of teaching challenges from their experience as nurse educators. These stories were then used to inform script development for the CIVs. During the focus groups, participants were asked to watch and respond to the videos to confirm that the CIVs captured teaching challenges and could generate rich discussion. This mixed-methods study involved three parts: (a) an online survey, (b) the development of CIVs, and (c) focus group participation.

Nursing faculty members from across a New England state were invited to participate in an online survey. Challenges in teaching identified from the survey were used to develop CIVs. A subsequent invitation asked faculty members from across the same state to participate in focus groups. During the focus groups, participants role-played responses and provided feedback regarding the CIVs. The focus groups were used to determine if the CIVs captured the identified teaching challenges revealed by the survey. Through group participation in the process, PAR allowed for the discovery of knowledge and development of a teaching methodology that addressed teaching issues experienced by nurse educators. The study was approved by the university's institutional review board, and participants provided written consent for participation in each part of the study.

Study Design

Survey

A Google™ survey was created by the researchers and emailed to nursing faculty members at both public and private institutions via their school email address. The survey items were determined based on faculty experience and informed by the nursing education literature. Two external experienced nurse educators reviewed the survey to establish validity.

The three-part survey asked about common classroom and clinical teaching challenges. Part one asked participants to consider the same two questions for both classroom and clinical settings. From a prepared list of 10 challenges (Figure 1), participants were asked to choose all they have encountered. The second question asked participants to then identify their top three challenges. Part two of the survey included three open-ended questions that asked for examples of teaching challenges they experienced, related to the choices selected in part one. Part three of the survey contained three demographic questions.

Most common teaching challenges.

Figure 1.

Most common teaching challenges.

CIVs

CIVs were based on survey data from faculty participants and were produced using an iPhone® X and iMovie® software. The data collected from the survey were used to determine what challenges to include and prioritize in the making of the CIVs. Key themes were developed from analyzing the common challenges denoted in part one of the survey and the examples of selected challenges provided in part two. From the most common challenges, clinical and classroom scenarios were developed, and scripts were written. CIVs were then created to dramatize the key themes using SON students, staff, and faculty members as actors. The CIVs were designed to reflect the complexities of teaching practice in the form of challenging interactions across the roles of staff RN, student, and teacher; produce a visceral response from the viewer; and limit cognitive load. To accomplish this, the CIVs were short (less than 2 minutes in length) and included both visual and audio components. For example, in one CIV, students were portrayed as being bored in clinical settings, and the clinical instructor overhears the exchange. In another CIV, a student confronts the didactic teacher about a low test score. The CIVs end abruptly without a resolution, and the viewer is asked to respond.

The operationalized chart (Table 1) details the situations portrayed in the 10 CIVs, the individual roles, the environment where the scenario took place, and the challenge addressed.

The Operationalization of Key Domains in CIV Creation

Table 1:

The Operationalization of Key Domains in CIV Creation

Focus Groups

Nursing faculty members across the state were electronically invited to participate in one of four 2-hour focus groups held in different locations. The purpose was to evaluate whether the CIVs captured the reality of teaching challenges. After viewing the CIVs, participants were asked to use cognitive rehearsal in the form of role-playing to determine whether the videos would facilitate meaningful discussions about teaching. This activity involved an open-ended question asking the viewer to resolve the situation, such as, “How would you respond to the student?” The activity concluded with a facilitated debriefing using an advocacy-inquiry approach (Clark & Fey, 2019).

The focus groups were audiorecorded and transcribed by a third party. Rigor was established in the following ways:

  1. The presence of both researchers at the focus groups kept detailed notes and debriefed each group.

  2. The researchers separately listened to the audio recordings to ensure transcription accuracy followed by coding line by line.

  3. The researchers read the transcripts repeatedly together to come to consensus regarding coding and theme identification.

  4. When there was disagreement about the coding, the researchers reread transcripts and discussed them until a coding agreement was reached.

Coded data were reviewed, themes were determined, and participant quotes were edited for flow. Quotes from participants were representative of all focus groups.

The trustworthiness of the survey was confirmed through triangulation in viewing the CIVs and discussions within the focus groups. The same teaching challenges were exposed from the survey and yielded no additional challenges. The four focus groups were sufficient to reach data saturation.

Results

Survey

A convenience sample of 50 faculty members completed the survey (N = 50). Most participants were between the ages of 46 and 60 years (Figure 2), with 58% having a Master of Science in Nursing degree (Figure 3). More than 50% had been teaching in the classroom 8 or more years, and just under 25% had 3 years or less of clinical teaching experience (Figure 4).

Age of participants in years.

Figure 2.

Age of participants in years.

Highest education level of participants. Note. ADN = Associate's Degree in Nursing; BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing; and MS = Master of Science.

Figure 3.

Highest education level of participants. Note. ADN = Associate's Degree in Nursing; BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing; and MS = Master of Science.

Years teaching in the clinical setting and classroom.

Figure 4.

Years teaching in the clinical setting and classroom.

Part one of the survey identified participants' teaching challenges (Figure 1), and part two provided responses to open-ended questions asking for examples of encounters faced by participants. These examples were considered during the development of CIV scripts. The top three challenges identified in the classroom were student preparation (87.8%), student motivation (61.2%), and student attitude (46.9%). The top three challenges identified in the clinical setting were student preparation (56.1%), student knowledge (43.9%), and communication (43.9%) (Figure 1).

Focus Groups

A total of 21 nursing faculty members participated in four focus groups that met over a period of 2 months. There was consensus that the CIVs captured a reality that participants have experienced. One participant stated, “OMG, I've had this [happen].” Another participant said, “...[the videos] brought back memories. I've been in similar situations.” Participants expressed that the CIVs accurately addressed challenges experienced in either the classroom or clinical settings.

Participants voiced surprise by the amount of discussion the CIVs generated, stating, “I would never think a 30-second clip could generate so much conversation.” The CIVs prompted an introspection regarding participants' experiences of teaching. Participants responded that role-playing and debriefing “...gets you to think about teaching in a different way.” Another participant mentioned, “these conversations [in the focus group]…provided opportunities for everyone to learn, to reflect and say, ‘Huh, I like the way that was done.’”

Overall, the focus group discussions yielded six key themes: Role Clarification, Isolation, Teaching Communication, Teaching Learning to Learn, Teacher Development, and Usefulness.

Role Clarification

Participants identified they did not share a consistent understanding related to the roles of instructor, student, and staff RN. This was highlighted by comments such as, “We're not employees, we're guests,” and “I don't want to be a burden to the nurse.” Participants reported that role confusion can lead to conflict and instructors withdrawing from the interaction. One participant concluded, “I didn't even go there with that nurse… and I guess that's maybe because this is where I struggle as an instructor.” Another participant noted, if conflict is left unresolved, “they [nurses] do become hostile, and it becomes an awful environment for the student to learn, because the nurses treat them [students] crappy.”

While discussing roles, the conversation included the issue of professional boundaries. Issues that surfaced most often were centered around the students' desire to help staff RNs or instructors and students being asked to perform nursing tasks unrelated to student learning. This was especially true when the clinical instructor was also employed by the institution as a staff RN. Participants who were clinical instructors and employed in the same unit found it necessary to communicate this role change to their peers by wearing a laboratory coat when in the unit as an instructor. This strategy resulted in less confusion and conflict for everyone.

Isolation

Teaching in isolation was a theme that grew out of the discussion related to both classroom and clinical settings. One participant stated:

So much of what we do in education is done in isolation and we need to create ways in which we come together so that you have a support system. Even as a full-time faculty member, I'll go days, weeks without necessarily seeing a colleague, let alone have any meaningful conversation.

There was agreement that faculty members need to be able to discuss student concerns so as not to feel isolated. As one participant stated, “...because if they're [students] struggling in one [course], most often they're struggling in another.” Yet, one participant reported the feeling that she wasn't “allowed to talk about a student by name to another faculty member. That's always been the impression I got, that it was like a no-no.”

The topic of teaching in isolation also led to a discussion about how to handle uncivil confrontations from students, especially those confrontations that have the potential for violence. Participants specifically addressed issues of isolation, including discussions of teacher safety, which is seldom brought up in nursing education courses or orientations.

Teaching Communication

The importance of the instructor role modeling communication strategies was mentioned many times by participants across focus groups. As noted by one participant, “Part of our role is role modeling and saying [to the student] there's a disconnect here [between what the student hears and communicates].” Participants felt a responsibility to not only model professional communication but also involve students in addressing communication within situations effectively. This was highlighted in one response, “I think it's important for us to go find the student and have a conversation about what was going on [in the situation].”

When participants viewed a CIV in which a staff RN directed incivility toward an instructor, responses were mixed. For example, one participant stated, “Yeah, I would have addressed her [the staff RN's] tone. Right then and there. I would have done it in a professional way, but I have no tolerance for incivility toward me.” In contrast, another participant responded, “If it was me in that situation, I would have retreated.” Another participant added, “I would also [use the opportunity to] promote the whole conflict resolution piece and accountability [with the student].” Exploring ways to handle communication clearly brought about different concerns by the participants and stressed the value of debriefing with students in these situations.

Teaching Learning to Learn

This theme reflected participants' desire to understand and teach students ways to learn more effectively. There was consensus among participants that instructors need to make ways in which students learn to “think like a nurse” more visible. The types of questions instructors might ask students and what information to gather to assess learning and provide feedback on their progress were discussed.

One participant shared that her first inclination was to “tell students [facts] rather than having them come up with the information themselves.” Another participant added, “I don't want to jump to giving an explanation when I can further benefit the student by having them flesh out what they are thinking.” Participants noted that helping students to begin to think like a nurse involved asking questions that allow students to connect what they have learned with clinical situations. One participant realized that, “We talked about those sort of things [observation skills] and used it to broaden the experience, [to] get them [students] to start looking and seeing things that we see as experienced RNs.” Participants noted that having an ability as the teacher to be curious and ask questions led to deepening the learning experience for students.

CIVs depicting a clinical environment prompted a discussion about students internalizing the concept of accountability toward understanding their ability to think like a nurse. An observation was made by some participants that students do what the staff RN tells them before thinking it through or forming a plan on their own. Comments included, “But the whole point was getting this student to recognize as a professional nurse to make your own assessment,” and “This is a good moment to stress you have to be responsible for your own actions.”

Another element within the theme of learning to learn was being able to recognize and accentuate the positive when giving feedback to students. This was highlighted by comments such as, “First off what comes to mind is I would probably thank [the student] for bringing this issue to my attention,” and “I'm impressed with the student…. She's done her homework, she checked her labs, she's done some assessment…. I would praise the student.”

Viewing the CIVs led to a discussion about strategies for studying and doing well on examinations. Consensus among participants was that faculty need to help students develop effective study habits. Participants talked about the need for students to recognize that merely memorizing facts was not sufficient. When discussing examinations, one participant pointed out, “We talked about not overthinking questions, [you need to] read the question...and recognize what it is asking.”

In addition to learning strategies, participants also acknowledged other questions that need to be explored, such as assessing basic needs, sleeping habits, and how students spend their time. One participant asked questions such as, “Do you own the book? How many hours are you studying? How many hours are you working?” and “Sometimes you have to ask what else is going on with the student.”

Teacher Development

Another theme explored with participants was the process of becoming a teacher. Participants agreed that viewing the CIVs and then participating in a debriefing offered opportunities for exploring various situations as an educator. One participant noted, “[This] scenario was relatively new to me,” and confirmed that the videos created further discussion of events that would likely happen in teaching.

Some participants noted that there is a developmental process to becoming an educator although the way in which this unfolds can be different for everyone. “So, when I first started teaching I made [students] cry and then I just slowly became more gentle…. I didn't understand the [student] developmental issues in the beginning.” In sharp contrast to this, another participant commented, “Right, same for me but I was too gentle in the beginning and needed to become much more straightforward as I became an educator, realizing I was letting them [students] get away with murder.”

CIVs helped participants to reflect on teaching struggles. One participant shared, “Well I guess to me, the big question, the first question I had was, what do we do when students come to the clinical setting unprepared?” Another struggle that was mentioned was how to respond when staff RNs refuse to work with students, “But I don't want to run from the nurse who doesn't want to have students and may even say to the student, ‘This may be challenging, that's part of what we're going to talk about today [in post conference]….’ Like, I may turn it into learning.”

Participants reported a lack of engagement from students where the instructor finds themselves doing more work than the student, such as rewriting sentences in an assignment or answering questions that the student ought to be looking up on their own. This led to a discussion about how teachers can set boundaries. One suggestion was to help students navigate learning and use knowledge by posing questions rather than giving facts. By asking questions, participants realized teachers can help students to become curious about learning on their own.

Another example of boundary setting explored relationships and social media. Participants' comments reflected that some faculty believed it was appropriate to communicate both personally and professionally with students on social media, whereas others disagreed. One participant responded, “I've seen adjunct faculty want to be best friends with students and they're on Facebook® and Twitter™…sharing personal experiences.” In contrast, another participant stated, “Then in the clinical setting, I'm all business and I'm not going to be Facebook friends until you graduate.”

Usefulness

Participants found CIVs to be useful on multiple levels and were surprised by the richness of the interactions and debriefings. Whether participants were new or experienced teachers, role-playing and self-reflection were described as meaningful and valuable. One participant said, “I found these videos [to be] really helpful, even for myself, as I consider myself an experienced educator...and I found that it helped me reflect and gain some insight.” Another participant added that she was surprised by the simplicity, yet complexity, as debriefing resulted in rich discussion. This awareness led another participant to comment, “I like the fact that they are so relatively bare bones, that there are so many unanswered, unprovided details...it allows us [teachers] to fill in the blanks.”

Another discovery was that CIVs allowed for flexibility of use, with one participant stating, “We talked about the fact that there were multiple layers of problems [within the videos].” Participants commented that CIVs could be adapted in multiple ways, “By leaving it open, without knowing if it's a first year student or a last-year student, you've created two different conversations.” Participants realized that the CIVs could provide multiple teaching foci depending on the learning purpose.

Discussion

The aim of this project was to introduce and evaluate a cognitive learning strategy that allowed faculty to think through and practice responses to various teaching situations portrayed in CIVs. The CIVs provided opportunities for participants to experience cognitive rehearsal in the form of role-playing. CIVs were short in duration, had limited cognitive load, and were found to be beneficial by creating a space to practice and debrief. Responses by participants reflect that CIVs are highly effective and useful when creating a simulated interactive learning experience. The same experience could be inferred if CIVs were used as part of an orientation to the teacher role and for ongoing faculty development.

CIVs allowed participants to reflect deeply about the constructs of their teaching. Given that CIVs depict challenging situations, they offered the opportunity to discuss teaching in ways that seldom happen during an academic year. SONs might find it useful to use CIVs for faculty development to stimulate meaningful discussions about teaching. These interactions address one concern voiced by participants in this study regarding isolation experienced in teaching.

On the topic of isolation, participants reported an awareness of teaching in isolation. Because of feeling isolated, participants mentioned that faculty, especially part-time faculty, expressed being unhappy and disenfranchised by their teaching experiences. This created a concern that some faculty members might leave teaching altogether. At a time when the faculty shortage is growing, support for faculty and efforts to mitigate feelings of isolation must be addressed.

Another concern raised during discussion of isolation was safety and the importance of being aware that students do get angry with faculty members. CIVs offered an opportunity for teachers to explore how to handle an unsafe situation. An extreme example would be discussing the 2002 shooting and killing of three nursing faculty members at the University of Arizona (Holguin, 2002). Further exploration and education are needed to address faculty safety and how to best deescalate situations involving incivility and violence.

The importance of practicing communication strategies was frequently addressed in participants' reflections. Consistent with Griffin's (2004) findings, cognitive rehearsal in the form of role-playing created space to practice communication strategies and solutions. The CIVs elicited emotions and, along with the lack of resolution, enhanced the value of cognitive rehearsal and influenced role-playing by making it “more real.” This was beneficial because it moves learning into working memory. The more one practices, the easier one can address similar situations in the future (Clark & Fey, 2019).

CIVs were an effective method for faculty development in understanding roles of faculty, students, and staff RNs. Clarification of roles is essential in creating an optimal learning environment and, at the same time, providing quality nursing care. The role of the instructor is to assist students with their learning and to assess and evaluate students. Actions of the teacher need to be in relationship to student learning. The role of the student is to learn. It is through this learning that students provide care. The role of the staff RN is to ensure patient care needs are met. CIVs assisted participants in being aware of professional boundaries and how to reframe events from a student learning perspective.

CIVs provided a platform for participants to reflect on how to assist students with ways to learn more effectively. Through understanding how learning happens, participants were able to discuss various responses that would help students learn, rather than merely recite facts. Through discussion, educators came to realize that asking questions about how students learn and think helped to focus teaching strategies for learning, such as addressing basic studying needs and how to think like a nurse.

This PAR study demonstrated that CIVs were a meaningful way to address the learning needs of nursing faculty. The CIVs were constructed in such a way that their simplicity provided flexibility that allowed them to be tailored to a range of learning possibilities. CIVs provided a context for discussions that moved from the specific situation to broader conversations when additional details were introduced. Because of this flexibility, the CIVs demonstrated expanded usefulness in deepening the learning experience.

The findings from this study support that CIVs were able to capture teaching challenges and successfully engage participants in discussions about teaching practice. Used as a cognitive strategy, CIVs offered participants the ability to practice teaching responses in an interactive learning environment. Moreover, interactive experiences using CIVs assisted in generating new knowledge about teaching and show promise as a method for faculty development.

Limitations

There were several limitations to this study. The lack of variation in sampling limited the transferability of findings due to the homogenous nature of participants. Participants were from one state, and those who attended the focus groups were from baccalaureate programs. Although all participants were currently teaching in SONs, none were new to academia; therefore, the study did not reflect how new teachers might view CIVs. The authors are nursing faculty members within the same baccalaureate program and teach in the same state where the study was conducted. This had the potential to create an unconscious bias regarding the process, results, and conclusions. From the possible teaching scenarios that could be created, production was limited to 10 CIVs.

Implications for Nursing Education

The findings presented in this PAR study have broad implications for nursing education. The results support that CIVs captured teaching challenges and discussions about teaching through cognitive rehearsal and deliberate reflection. In the preparation of nurse educators, CIVs would be an ideal interactive learning experience to be included in Master of Science in Nursing education programs. Furthermore, CIVs could easily be integrated into orientation for new hires. Experienced educators can benefit from using CIVs as an opportunity to reflect on their teaching and share their experience and wisdom with others. The development of a controlled study measuring the long-term usefulness of CIVs and the impact on job satisfaction and faculty retention would be warranted.

Further research to determine generalizability of the CIVs' usefulness by designing studies that include multiple SONs would be beneficial. Development of additional CIVs reflecting other teaching challenges would add value to and expand their usefulness. The development of a manual that provides direction on how best to use CIVs and making them available for online learning platforms would be another way to expand accessibility.

Conclusion

This study integrated a cognitive learning strategy that used CIVs to create opportunities for nurse educators to practice responding to challenging situations in a simulated environment designed to promote reflection and learning. CIVs captured realistic teaching challenges and offered an ideal opportunity to practice communication skills, handle conflict, set boundaries, address role clarification, and think through possible outcomes. CIVs offer a pedagogical approach in addressing the learning needs of the nurse educator and have the possibility to assist SONs in meeting national recommendations that transform nursing education in the 21st century.

References

  • American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf
  • American Association of Colleges of Nursing. (2019). Nursing faculty shortage fact sheet. https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage
  • Bartels, J. E. (2007). Preparing nursing faculty for baccalaureate-level and graduate-level nursing programs: Role preparation for the academy. Journal of Nursing Education, 46(4), 154–158 doi:10.3928/01484834-20070401-03 [CrossRef] PMID:17474484
  • Benner, P., Sutphen, M., Leonard, V. & Day, L. (2010). Educating nurses: A call for radical transformation (Carnegie Foundation for the Advancement of Teaching). Jossey-Bass.
  • Bhattacharjee, S. (2014). Effectiveness of role-playing as pedagogical approach in construction education. https://www.semanticscholar.org/paper/Effectiveness-of-Role-Playing-as-a-Pedagogical-in-Bhattacharjee/d1f0545f776b79c6f3925ae4a06eb18c76c1558b
  • Booth, T. L., Emerson, C. J., Hackney, M. G. & Souter, S. (2016). Preparation of academic nurse educators. Nurse Education in Practice, 19, 54–57 doi:10.1016/j.nepr.2016.04.006 [CrossRef] PMID:27428693
  • Cambridge Cognition. (2015, August19). What is cognition?https://www.cambridgecognition.com/blog/entry/what-is-cognition
  • Christensen, L. S. & Simmons, L. E. (2020). The scope of practice for academic nurse educators and academic clinical nurse educators (3rd ed.). National League for Nursing.
  • Clark, C. M. & Fey, M. K. (2019). Fostering civility in learning conversations: Introducing the PAAIL communication strategy. Nurse Educator, 45(3), 139–143 doi:10.1097/NNE.0000000000000731 [CrossRef] PMID:31498196
  • Diekelmann, J. & Diekelmann, N. (2009). Schooling learning teaching: Toward narrative pedagogy. Universe.
  • Fang, D. & Htut, A. M. (2008). Special survey of AACN membership on vacant faculty positions for academic year 2008–2009, July, 2008. http://www.aacnnursing.org/portals/42/news/surveys-data/vacancy08.pdf
  • Fang, D. & Kesten, K. (2017). Retirements and succession of nursing faculty in 2016–2025. Nursing Outlook, 65(5), 633–642 doi:10.1016/j.outlook.2017.03.003 [CrossRef] PMID:28579147
  • Gaberson, K. B., Oermann, M. H. & Shellenbarger, T. (2015). Clinical teaching strategies in nursing (4th ed.). Springer.
  • Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing, 35(6), 257–263 doi:10.3928/0022-0124-20041101-07 [CrossRef] PMID:15584678
  • Griffin, M. & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535–542 doi:10.3928/00220124-20141122-02 [CrossRef] PMID:25406637
  • Holguin, J. (Oct29, 2002). 4 dead in University of Arizona shooting. CBS news https://www.cbsnews.com/news/4-dead-in-univ-of-arizona-shooting/
  • Jeffries, P. R. (2012). Simulation in nursing education: From conceptualization to evaluation (2nd ed.). National League for Nursing.
  • Josephsen, J. (2015). Cognitive Load Theory and nursing simulation: An integrative review. Clinical Simulation in Nursing, 11(5), 259–267 doi:10.1016/j.ecns.2015.02.004 [CrossRef]
  • Keyt, J., Li, Y. & Fang, D. (2019). Special survey on vacant faculty positions 2019–2020. Research and Data Center AACN. https://www.aacnnursing.org/Portals/42/News/Surveys-Data/Vacancy19.pdf
  • Khiri, B. & Mohammadi, E. (2016). Identifying educational methods for developing entrepreneurship and employment at applied scientific centers of Ilam Province. International Journal of Humanities and Cultural Studies, 3(1), 630–639.
  • Krautscheid, L., Kaakinen, J. & Warner, J. R. (2008). Clinical faculty development: Using simulation to demonstrate and practice clinical teaching. Journal of Nursing Education, 47(9), 431–434 doi:10.3928/01484834-20080901-05 [CrossRef] PMID:18792712
  • Mangan, K. (2011). Nursing schools increasingly turn to part-time faculty. The Chronicle of Higher Education. https://www.chronicle.com/article/Nursing-Schools-Increasingly/127727
  • Martinez Riera, J. R., Cibanal, J. L. & Perez Mora, M. J. (2010). Using role playing in the integration of knowledge in the teaching-learning process in nursing: Assessment of students. Texto Contexto Enferm, Florianopolis, Out-Dez, 19(4), 618–626.
  • McPherson, S. (2019). Part-time clinical nursing faculty needs: An integrated review. Journal of Nursing Education, 58(4), 201–206 doi:10.3928/01484834-20190321-03 [CrossRef] PMID:30943294
  • National League for Nursing. (2011). A vision for post-baccalaureate nursing education: A living document from the National League for Nursing. http://www.nln.org/aboutnln/livingdocuments/pdf/nlnvision_3.pdf
  • National League for Nursing. (2014). Nurse educator shortage fact sheet. http://www.nln.org/docs/default-source/advocacy-public-policy/nurse-faculty-shortage-fact-sheet-pdf.pdf?sfvrsn=0
  • National League for Nursing. (2017). Highest earned credential of part-time nurse educators. Faculty Census Survey 2016–2017. http://www.nln.org/docs/default-source/default-document-library/highest-earned-credential-of-part-time-nurse-educators-by-rank-2017.pdf?sfvrsn=0
  • National League for Nursing Board of Governors. (2002). The preparation of nurse educators. http://www.nln.org/aboutnln/PositionStatements/preparation051802.pdf
  • National League for Nursing Board of Governors. (2013). Doctoral preparation for nurse educators a living document from the National League for Nursing. http://www.nln.org/docs/default-source/about/nln-vision-series-%28position-statements%29/nlnvision_6.pdf?sfvrsn=4
  • Oermann, M. H. (2017). Preparing nurse faculty: It's for everyone. Nurse Educator, 42(1), 1 doi:10.1097/NNE.0000000000000345 [CrossRef] PMID:27906819
  • Polit, D. F. & Beck, C. T. (2017). Designing qualitative studies to generate evidence for nursing. In Nursing research: Generating and assessing evidence for nursing practice (pp. 482–518). Wolters Kluwer Health.
  • Santisteban, L. & Egues, A. L. (2014). Cultivating adjunct faculty: Strategies beyond orientation. Nursing Forum, 49(3), 152–158 doi:10.1111/nuf.12106 [CrossRef] PMID:25099822
  • Schoening, A. M. (2013). From bedside to classroom: The nurse educator transition model. Nursing Education Perspectives, 34(3), 167–172 doi:10.1097/00024776-201305000-00007 [CrossRef] PMID:23914459
  • Sorrell, J. M. & Cangelosi, P. R. (2015). Expert clinician to novice nurse educator: Learning from first-hand narratives. Springer. doi:10.1891/9780826125996 [CrossRef]
  • Suplee, P. D., Gardner, M. & Jerome-D'Emilia, B. (2014). Nursing faculty preparedness for clinical teaching. Journal of Nursing Education, 53(3), S38–S41 doi:10.3928/01484834-20140217-03 [CrossRef] PMID:24530012
  • Sweller, J. (1988). Cognitive load theory. In Mestre, J. P. & Ross, B. H. (Eds.), Psychology of learning and motivation (Vol. 55, pp. 37–76). Elsevier. doi:10.1016/B978-0-12-387691-1.00002-8 [CrossRef]
  • van Merriënboer, J. J. & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44, 85–93 doi:10.1111/j.1365-2923.2009.03498.x [CrossRef] PMID:20078759
  • Woodworth, J. A. (2017). Adjunct nurse faculty demographics and intent to stay teaching. Nurse Educator, 42(6), 295–298 doi:10.1097/NNE.0000000000000376 [CrossRef] PMID:28353486

The Operationalization of Key Domains in CIV Creation

Video TitleIndividualsEnvironmentChallenge
“What are you going to do?”Instructor, staff RN, studentClinical unitAttitude, incivility, communication, roles
“Unprepared for meds”Instructor, studentClinical, med roomAttitude, student preparation, knowledge
“Underprepared for clinical”Instructor, studentClinical, med roomStudent preparation, attitude, motivation, knowledge
“RN complain, nursing student”Instructor, staff RNClinical, staffing roomAttitude, incivility, communication
“Foley removal”Student, staff RNClinical, utility roomAttitude, ethical, communication
“No charting”Instructor, staff RNClinical, charting areaAttitude, incivility, communication, roles
“Over prepared”Instructor, studentClassroom, officeStudent preparation, attitude
“Incivility over exam”Instructor, studentClassroom, officeAttitude, incivility, communication
“Bored”Instructor, studentsClinical, charting areaAttitude, student motivation
“Tell me what I need to know”Instructor, studentClassroom, officeStudent preparation, motivation, knowledge
Authors

Dr. Cynthia Randall is Assistant Professor, and Dr. Carla Randall is Associate Professor, School of Nursing, University of Southern Maine, Portland, Maine.

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

Address correspondence to Cynthia S. Randall, DNP, RN, CNL, CHSE, Assistant Professor, School of Nursing, University of Southern Maine, PO Box 9300, Portland, ME 04104; email: cynthia.randall@maine.edu.

Received: May 09, 2020
Accepted: August 12, 2020

10.3928/01484834-20210120-05

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