F.A. Davis Effective Teaching Strategies for New Faculty

STRATEGIES FOR Effective Teaching A GUIDE FOR NEW FACULTY

Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting

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Jason Martinez and Angela Miller, two new faculty members, are commiserating with each other about their roles as nursing instructors. “I know how to be a nurse—I even know how to teach patients. But how in the world do you teach in a class, lab, and clinical so that students will be successful on the NCLEX exam and in practice?” Jason says. Angela agrees. “The only thing I know to do is to teach the way I was taught. But things have changed—there is WAY more content to cover than when I was in school.”

Health care, and nursing specifically, are certainly more complex than 20 or even 10 years ago. In addition, advances in technology which allow researchers to study the functioning of the brain, have given educators clues to strategies for improving students’ learning. Let’s delve into three strategies new educators can use to increase the effectiveness of their teaching and prepare students for the complex healthcare environment.

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Encourage student engagement in learning 1. Many of us remember the days when going to class meant listening to an instructor’s lecture, frantically trying to take notes of the important points—and wondering what the important points were! Today we know that if students are engaged in the topic under consideration, thinking critically about the subject matter and under- standing ways in which the material can be applied in a context (like a clinical situation), they are more likely to apply what they have learned in another situation. When the instructor sets up such an environment, student engagement with the learning is more likely to occur. Understanding what student engagement means is the first step in this process. The box below provides a definition of student engagement. In contrast, when an instructor spends most

Definition of Student Engagement Students pay attention, demonstrate curiosity, interest, and passion about the learning process. These emotions increase the student’s motivation to remain on task and learn. Student Engagement is “a psychological investment in learning.”

of the time in class talking, rather than listening, student engagement is less likely to be present.

Why? Research on the brain finds that one’s attention span tends to be about 10-20 minutes at a time. During that period, the

brain makes a quick determination of what is important. If the content being provided in a class does not feel important to the student, their thoughts will move on to something they do consider important—maybe even what they will have for lunch. So HOW can instructors engage students in class, lab, and clinical experiences? Euler (2018) reviewed literature in psychology, biology, and neuroscience to determine the most current evidence regarding how humans learn. He identified five conditions within the student which, if present, will improve their engagement: 1. CURIOSITY —the student is interested in knowing more about the content being discussed. 2. SOCIAL BELONGING —connection to the teacher and other students by sharing ideas and experiences provides the feeling of belonging to a group. 3. EMOTION —dry facts won’t spark a student’s engagement; emotions must be tapped. Considering how abnormal lab values affect a client’s condition is much more likely to stimulate an emotion than being required to learn normal and abnormal lab values without a client context. 4. FAILURE —if humans fail and they are provided with an opportunity to reflect on the failure, they may learn different approaches when faced with a similar circumstance in the future. Helping students

recognize that failure is a part of learning is an effective teaching strategy. 5. AUTHENTICITY —the recognition that a situation being discussed is “real.”

Certainly, it is much easier for students to be engaged in a well-designed lab or actual clinical experience because these activities, by their very nature, require students to be engaged. However, what can we do to encourage student engagement in the classroom? Nursing students learn by and in situations that involve clients. Bringing clinical into the classroom, as described by Benner, et. al, (2010) requires the use of case studies, clinical stories, and discussions about client care. This approach requires instructors to shift the focus in class from content about diseases to nursing care of clients with selected diseases. For example, in the past, nursing instructors have lectured in depth about the pathophysiology of diabetes mellitus. Today, the focus in the classroom should be caring for a patient with symptoms of diabetes based on an understanding of the pathophysiology.

Provide opportunities for students to use clinical judgment 2. Since 2012, the National Council of State Boards of Nursing (NCSBN), the organization that develops the NCLEX® Licensure Examination, has been working on a revision of the NCLEX for both RNs and PNs. This approach emphasizes the nurse’s effective use of clinical judgment. In the revised NCLEX exam, known as the Next Generation NCLEX (NGN) , the questions will focus on a client situation, include some unfolding case studies, and require the test-taker to use clinical judgment to correctly answer the questions. The NCSBN has developed a Clinical Judgment Measurement Model (CJMM), to illustrate the use of clinical judgment in nursing practice. This model guides how the Next Generation NCLEX (NGN) will measure the clinical judgment of the test taker. The NCSBN NGN website has resources available for educators as they transition to this new model. Terms such as critical thinking, problem solving, and clinical judgment are familiar terms in nursing, but the NCSBN has clarified the difference among these terms, as is shown in the figure below.

CRITICAL THINKING Using logic and reasoning interventions to resolve complex problems. (Unseen)

PROBLEM SOLVING Developing and evaluating interventions to resolve complex problems. (Unseen)

CLINICAL JUDGMENT Recognizing cues about a clinical situation, generating and weighing hypotheses, taking action and evaluating outcomes for the purpose of arriving at a satisfactory clinical outcome. Clinical judgment is the observed outcome of problem solving and critical thinking.

A key component of the Clinical Judgment Measurement Model is the identification of cognitive skills required to make an effective clinical judgment. The NGN test questions will require students to use these skills to answer the questions correctly, thus replicating decisions that nurses will make in actual practice. Preparing students for the NGN—and clinical practice—will require faculty to consistently provide opportunities for students to use clinical judgment skills in class, lab, and clinical experiences. Table 1 outlines the cognitive skills necessary for effective clinical judgment as well as relevant questions instructors should ask to help students learn these skills (NCSBN, 2019).

TABLE 1: Cognitive Skills of Clinical Judgment

Cognitive Skills in Clinical Judgment

Definition

Relevant Questions

Identifying relevant and important information from different sources (medical history, vital signs, assessment data)

What information is relevant/irrelevant? What information is most important?

Recognize Cues

What client conditions are consistent with cues? Why is a cue of concern? What other information do you need?

Organizing and linking cues to client’s clinical presentation

Analyze Cues

Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk, time) Identifying expected outcomes, using hypotheses to define interventions to reach expected outcomes

What explanation seems most/least likely? What possible issues are the most serious?

Prioritize Hypothesis

What is a desirable outcome? What interventions can achieve those outcomes? What should be avoided?

Generate Solution

Implementing solution that addresses highest priority

Which intervention(s) is most appropriate? How should the intervention be accomplished?

Take Action

What signs point to improving/declining/ unchanged status? Were the interventions effective? Would other interventions have been more effective?

Comparing observed outcomes against expected outcomes

Evaluate Outcomes

Build opportunities for students to reflect on their performance 3. Building opportunities for students to reflect on their performance throughout class, lab, and clinical experience is a third strategy for effective teaching. Not only is reflection helpful after a failure, but reflection also has benefits in all sorts of learning situations. For example, reflection encourages students to take charge of their own learning by reviewing a particular situation several times, exploring it from different points of view. This helps student to examine their own performance with more clarity than they might be about to do “in the heat of the moment” (Webb, 2018). Reflection can also help students build stronger connections among learning experiences. For example, when reflecting on the care they gave to an older adult, they may be able to see similarities and differences between this client and a younger adult. Reflection also encourages social interaction among instructor and students. Discussion of various individual reflections by a group of students can provide a breadth of understanding for all students that might not be achieved without such discussion (Webb, 2018). Numerous approaches to the reflection process have been developed to help students reflect on their own performance. A simple and easy to use template, Look, Think, Learn, Plan , comes from Case Western Reserve Medical School (2020). Table 2 outlines those components in more detail and suggests some questions that will help students get started in each step of the reflection process.

TABLE 2: CaseWestern Reserve Medical School Reflection Template

Step

Questions to ponder

Look back at a situation or experience.

“How can I describe this situation?”

Think in depth about your experience or thoughts.

“My previous behavior might be because…” “Important ideas were…”

“I have learned that…” “I now realize…” “I wonder if…”

Describe what you learn ed about yourself or your role.

“I might do________ next time.” “I might change my thinking by…” “I may need to puzzle further…”

Plan what you will do next.

Faculty have the responsibility for preparing nursing students for an increasingly complex health care system. These three strategies can help you in your journey to becoming an expert teacher. Good luck on your journey.

References Benner, P., Sutphen, M., Leonard, V., Day, L. (2010) Educating Nurses: A Call for Radical Transformation. Preparation for the Professions. The Carnegie Foundation for the Advancement of Teaching. Case Western Reserve Medical School (2020) Four Steps for Reflection. Look, Think, Learn, Plan. https://case.edu/medicine/sites/case.edu.medicine/files/2020-09/4%20Step%20Reflection%20Template.pdf Accessed 2022. Euler, J. R. (2018) How humans learn: The science and stories behind effective college teaching. West Virginia Uni- versity Press. NCSBN (2019) Clinical Judgment Measurement Model. Next Generation NCLEX News. Winter, https://www.ncsbn.org/NGN_Winter19.pdf Accessed 2022.

Webb, L. (2018) Why reflection encourages better learning experiences. Learning Pool, https://learningpool.com/why-reflection-encourages-a-better-learning-experience/ Accessed 2022.

About the author Susan Sportsman, PhD, RN, ANEF, FAAN, is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas.

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