Teaching and Learning Strategies in Nursing Education
Introduction
Clinical education of undergraduate nurses remains an integral part of the nursing curriculum and forms the foundation for bridging the theory-practice gap. Nurse educators play a crucial role in guiding, supporting, stimulating, and facilitating learning in various practice settings, including hospitals, clinics, and primary healthcare sites. To optimize learning outcomes for nursing students, it is essential to identify and implement effective clinical teaching practices. This article explores various teaching and learning strategies in nursing education, including best clinical teaching practices, evidence-based practice (EBP) strategies, and strategies to promote student engagement.
Best Clinical Teaching Practices
Clinical teaching practice of nurse educators is important in the development of clinical competence of undergraduate nursing students, but it is often not done according to best practice standards. An integrative literature review was conducted according to Whittemore and Knafl’s adapted stages to summarise the best clinical teaching practices of nurse educators teaching undergraduate nursing programmes. A systematic search of electronic databases, including EBSCOhost and ScienceDirect, for applicable papers from January 2001 to June 2021, was followed by a manual search. The review resulted in the selection of 67 papers, and critical appraisal had been completed by two independent reviewers using relevant critical appraisal tools. The papers selected revealed six main themes, with sub-themes, outlining best practices for clinical teaching.
Planning for Clinical Teaching Practice
Adequate planning for clinical teaching involves self-preparation and planning for clinical placement. The expectation in terms of self-preparation is for the nurse educator to be competent in terms of clinical teaching and knowledgeable in terms of the clinical environment prior to conducting clinical teaching. In order to gain the required competencies, nurse educators should receive adequate preparation and support through professional development. Planning for placement of nursing students to the clinical sites is vital as this is where undergraduate nursing students acquire the knowledge and skills that enable them to be competent nurses. The role of the nurse educator is to assess the suitability of clinical placements, as determined by the availability of learning opportunities.
Facilitation of Students’ Clinical Learning
Effective facilitation of nursing students’ clinical placements involves orientation of students, planning for clinical teaching, and the clinical teaching process. Orientation of nursing students to clinical practice is vital in ensuring that they become informed about the nature of clinical practice. The orientation meeting between the nurse educator and nursing students at the beginning of the teaching programme, before clinical placement, should inform the students about the clinical practice requirements, practical skills to be practised, and assessment methods. Planning for clinical teaching implies that a well-coordinated programme of clinical placements should be prepared that takes into consideration correlation of theory to practice. This programme should encompass pre-contact preparation of the necessary documents - for example, copies of programme learning objectives, clinical assessment forms and feedback tools to be used in clinical teaching of nursing students. Of importance is recognition of previous experiences and learning needs of nursing students, finding out about their learning capabilities and making available appropriate learning resources.
Nurse educators involved in clinical teaching of nursing students should assist in bridging the theory-practice gap by providing clinical education to nursing students that enhances their application of theory in the conduct of their clinical practice, thus building the knowledge, skills and attitudes essential for professional practice. The included papers highlight four clinical teaching models which can be used in clinical teaching. The first, the traditional facilitation model aimed to utilise a nurse educator in clinical teaching in view of both academic and clinical expertise (dual role). However, the sharing of responsibilities by these nurse educators, coupled with a heavy workload, limited the effectiveness of the clinical teaching role. The second clinical teaching model, the preceptorship model, requires that the student is assigned to a registered nurse on a one-to-one basis. This is aimed at developing the professional knowledge and skills of nursing students in clinical practice, preparing them for their role-transitioning from student to graduate nurses through role modelling and feedback. The third model, the mentorship model, involves a qualified nurse being used to supervise nursing students on a one-to one basis to teach nursing students to expand their (practical) skills, overcome obstacles and build on their strengths to make positive choices and develop their practical skill so that they could become knowledgeable and well-rounded professionals. However, the workloads of and support required by mentor nurses should be carefully considered so that they may perform their mentoring function competently. The fourth clinical teaching model evident in the literature is that of an established dedicated education unit seeking to provide a positive clinical education environment for nursing students, facilitators and educational staff.
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Evaluation of Students’ Clinical Skills
Evaluation of students’ clinical skills involves reflection by the nursing student and feedback. The review’s results can be used in the development of a best practice guideline for clinical teaching.
Modelling Professional Clinical Teaching Practice
Modelling professional clinical teaching practice involves emotional intelligence, self-evaluation, role modelling, and continuous professional development.
Work-Based Assessment in the Clinical Environment
Work-based assessment in the clinical environment includes the clinical assessment process and clinical assessment tools.
Clinical Teaching in the Simulation Laboratory
Clinical teaching in the simulation laboratory provides a safe and controlled environment for students to practice and develop their clinical skills.
Evidence-Based Practice (EBP) Teaching Strategies
Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies.
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Interactive Teaching Strategies
Interactive methods including interactive lectures, small group work, journal clubs, reading quizzes, clinical nurse presentations, workshops and problem-based learning are needed in teaching EBP. An interactive approach involves an interaction amongst the participants. Effective learning reflects the quality of teaching. Learning though a constructivist approach refers to the creation of an environment in which the learner is an active participant who gains experience and engages in reflection, leading to problem-based, transformative learning. Interactive teaching strategies include research utilization, information literacy, and assignments as learning activities.
Research Utilization
Traditional teaching methods preparing students to use research were aimed at improving critical thinking skills, critically evaluating various literature sources and developing information literacy skills. Group work was also identified as a teaching strategy for establishing research utilization. The mixed-methods study conducted several workshops and monthly sessions to improve research competence among both lecturers and students. Experiential learning was often supplemented by collaborative group learning, such as partnerships for learning course content. The authors presented experiential teaching approaches as a motivational tool for improving research learning. The students used student-centred approaches and completed small group research studies. Assignments included carrying out a literature review, developing a proposal, facing a mock ethics committee, and collecting and analysing data. This student work was supported by pertinent lectures, including via ‘Blackboard’, a virtual learning platform. Finally, students presented their methodologic and analytic approaches on the virtual learning platform.
Information Literacy
Teaching information literacy and interdisciplinary collaboration, especially with librarians, is crucial for enhancing students' EBP knowledge.
Interactive and Clinically Integrated Teaching Strategies
Interactive and clinically integrated teaching strategies involve teaching EBP principles and clinical integration and collaborations.
Teaching EBP Principles
Four of the seven analysed studies included a vague focus on the use of EBP teaching strategies. Interactive teaching strategies are used, but primary strategies focus on searching for and critically appraising research for practice-based application.
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Clinical Integration and Collaborations
EBP teachers who collaborate with their students, and nurses in clinical practice also influence students’ integration of EBP. A mixed-methods meta-synthesis examining awareness and adoption of EBP stated that EBP skills for registered nurses and Bachelor of Science in Nursing (RN-to-BSN) students are influenced by exposure to partnerships and contextual teaching and learning, as well as clinical practice experience. Teaching and learning strategies have included clinical practicum projects, lectures, small group work, post-clinical conferences, online modules and simulations.
Learning Outcomes
Reported learning outcomes included enhanced analytical and critical skills and using research to ensure patient safety. Learning outcomes include enhancing analytical skills and changing attitudes toward utilizing research.
Enhancing Analytical Skills
An improved understanding of the differences between quantitative and qualitative methods was highlighted as an important aspect of preparation for nursing practice. Interactive strategies to teach the research process, critical appraisal and development of information literacy skills were also emphasized. Interactive learning activities such as problem-based learning, sharing information, flipped classroom and virtual simulation, workshops, group work and seminars with discussions were identified. In some studies, oral presentations of students’ research findings in a clinical setting were highlighted as an important part of the teaching and learning strategy.
Barriers
Reported barriers included challenging collaborations, limited awareness of EBP principles and poor information literacy skills. Barriers include information literacy skills and knowledge and challenging collaboration.
Information Literacy Skills and Knowledge
Nurses face challenges to EBP from their inability to locate and critically evaluate information.
Strategies to Promote Student Engagement
Students’ engagement in academic-related learning activities is one of the important determinants of students’ success. Identifying the best teaching strategies to sustain and promote nursing students’ engagement in academic and clinical settings has always been a challenge for nurse educators. Hence, it is essential to provide a set of strategies for maintaining and enhancing the academic engagement of nursing students.
Technology-Based Strategies
There is growing evidence that shows the value of technology for engaging students in academic learning activities. Technology-based strategies include Kahoot in the classroom, online teaching techniques, asynchronous discussion boards, posting videos on YouTube, virtual communities, and response systems (clickers).
Kahoot in the Classroom
Kahoot is a free web-based technology that incorporates a quizzing program to increase the participation of learners during the lecture. As well, it can be used as a mean for formative assessment of students. The underlying assumption of Kahoot method is that an interesting program could increase students’ participation during the lecture. This technique as an innovative tool for nurse educators for engaging students during the lecture.
Online Teaching Techniques
Along with advances in technology and the Internet, many traditional teaching methods have been transformed into interactive web-based educational methods. In recent years, web-based courses provide many opportunities for actively engaging nursing students in learning activities.
Asynchronous Discussion Boards
These boards enable multiple learners to engage in discussion with each other. All discussions of the learners are collected on a board and the members contribute their comments by responding to the initial discussion question or by responding to each other. Asynchronous discussion boards, by use of the Web and other Internet technologies, encourage deeper learning and help students to be more engaged in learning activities related to analysis, synthesis, decision-making, and the use of knowledge. In nursing education, educators can enhance students’ engagement by posting a series of questions on the discussion board and then encourage those students to reflect and respond actively to those questions.
Posting Videos on YouTube
A collection of YouTube videos into the bioscience course to support nursing students’ engagement. The videos are highly successful.
Virtual Community
An intervention called “the neighborhood virtual community (VC)” to assist first-semester baccalaureate nursing students in learning complex, health-related content. VC as an online teaching application presenting an imaginary community with multiple interconnecting character stories. VC included households’ and health care nurses’ characters. Engagement in learning activities were significantly higher in the experimental group than those of the control group. In addition, a significantly positive relationship between the frequency of VC use and perceived benefits among students was found.
Response Systems (Clickers)
Response systems are a set of software and hardware that educators have used to attract learners’ attention and increase their engagement during the class lecture. By asking questions in the classroom, the educator encourages the students to respond to these questions through a technology-based response pad called “clickers”. Using this system, students can get instant feedback from the educator regarding the asked questions. In this way, clickers actively engage students during the lecture.
Collaborative Strategies
Collaborative strategies involve group work, peer teaching, and team-based learning.
Active Learning Strategies
Active learning strategies involve engaging students in the learning process through activities such as case studies, concept mapping, and role-playing.
Simulation-Based Strategies
Simulation-based strategies provide students with opportunities to practice their skills in a safe and controlled environment.
Research-Based Strategies
Research-based strategies involve engaging students in research activities to promote critical thinking and evidence-based practice.
Additional Active Learning Strategies
With the patient care and hospital industries evolving so quickly, the way we approach nursing education and classroom learning styles should adapt and grow, too. Simply presenting course material may provide short-term value, but physical practicing, experiencing, and learning through active engagement helps the roots of that material grab hold. Educators who use active learning strategies in their nursing programs are able to teach to a variety of learners: visual learners, auditory learners, tactile learners, and yes, even those learners who have difficulty remaining seated.
- Prior to teaching a concept in class, ask your students to research key terms, review patient assessments, required medications or drug classes, and exemplars related to the concept.
- Try incorporating case studies that include visual cues, lab tables, and patient quotes to encourage discussion among students.
- Working NCLEX practice questions throughout your curriculum will have amazing long-term benefits on your nursing students when it comes time to buckle down and study leading up to the big exam. Have students answer example NCLEX questions individually and then guide and encourage a larger class debate on correct and incorrect answers.
- Have your nursing students act as patients, nurses, family members, and technicians in a skit presentation that reveals a deeper learning point for the rest of the class.
- Use concept maps to cover content acquisition, student assessment, or knowledge applications and then encourage them to take pictures of them on their phones to use as study tools. This style of active learning strategy is great for visual learners.
- Break students into groups and allow them to practice more hands-on interventions and procedures, like a code blue scenario, and use their critical thinking skills to react quickly and efficiently. You, as the educator, can participate and guide as necessary, but take a smaller role and encourage students to do the heavy lifting.
- This is a rapid-fire exercise where students shout out 5-10 concept-related terms that the instructor lists on a whiteboard.
- Place a number of boxes around the classroom with items and pictures related to that day's concept. Students will then use that to build a patient story and present it to the class. The class then brainstorms how a nurse might treat the hypothetical patient.
- For a gallery walk, scatter pictures and artifacts related to the day's concept around the classroom. Break students into small groups and have them wander throughout the room identifying each item and its relevance to the concept in terms of interventions, patients, and procedures.
- Faculty could create two (or more) scenarios of patients with the same symptoms and conditions, and students must discuss how they would treat the patients differently or similarly. This includes medication interventions, recommendations, diagnosis, etc.
- Use "what if" scenarios to transition between concepts or to review theories at the end of a class. Pose various "what if?" questions to individuals or small groups on a clinical situation to force their critical thinking skills.
Addressing the Nursing Shortage
From 2020 to 2021, the number of registered nurses (RNs) dropped significantly. According to the American Association of Colleges of Nursing (AACN), nursing programs turned away nearly 92,000 qualified baccalaureate and graduate applicants from nursing programs in 2021. The lack of faculty was a primary reason. As the nursing field works to address these challenges, a transformative change is happening in how nursing education is delivered. These teaching strategies include competency-based learning, simulation-based training, and virtual learning spurred on by the COVID-19 pandemic.
The Role of Nurse Educators
Nurse educators greatly impact the future of nursing and health care through hands-on instruction in clinical settings. An understanding of nursing practice standards prepares nurses to deliver high-quality care. Nurse educators are responsible for teaching nursing standards. They also advise nurses on their organizations’ unique care standards. Knowing how to use the latest technology is crucial for nurses. Outside of clinical settings, nurse educators can become nursing school faculty members who create engaging and supportive learning environments to foster critical thinking, sometimes contributing to the development of curricula. Besides helping students hone their clinical skills, nursing faculty members evaluate student performance, including reviewing coursework and lab and clinical work.
Trends in Nursing Education
The field of nursing is undergoing a transformative change to meet the evolving demands of health care delivery. Various drivers are igniting the change. Nurse educators are integral to helping ensure that nurses are well prepared for the future of nursing. One key step is to embrace shifts in nursing education. Another trend influencing nurse educators’ teaching strategies is the growing adoption of innovative technologies. For example, nurse faculty frequently employ online simulations to provide learning opportunities that promote critical thinking and decision-making. The shift toward competency-based education in nursing is another notable trend. Competency-based learning focuses on developing and assessing specific skills required for nursing practice, with an emphasis on hands-on experience, critical thinking, and problem-solving.
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