An EXCELLENT article on getting the most miles out of your classroom instruction (and preparing the students for the NCLEX examination):
Herman, J.W. (2002). The 60-second nurse educator: creative strategies to inspire learning. Nursing Education Perspectives, 9/1/2002
TODAY'S NURSE EDUCATORS serve multiple roles in the classroom. We are mentors, sages, entertainers, information jugglers, motivators, and more. One of our primary goals is to inspire. Through our connections with our students, we hope they will develop greater motivation and a greater capacity to learn, remember the information we impart and think about its relevance, and essentially "turn on" to learning.
The strategies presented in this article can be integrated into large classrooms, small classes, and clinical learning experiences. An inherent message is that content that is presented and reinforced in a fun manner will have a greater likelihood of being learned, and creating environments that celebrate learning will enhance nursing education (1).
We all face obstacles to using creative methods in the classroom, including lack of preparation time and insufficient class time, our own teaching style habits, the divergent learning styles of students, and the perceived need to cover all the content in class. The strategies presented here are quick, easy to implement, and transferable to a wide range of teaching topics and settings. It is important to remember that "shared perspectives, shared knowledge, and shared experiences are key foundational building blocks of creativity" (2, p. 675). Creating an atmosphere that promotes sharing and establishes rapport with students enhances learning and makes it memorable.
The Large Classroom Teaching in a large room with more than 50 learners offers significant challenges. The physical distance between teacher and learner can lead to an impersonal atmosphere in which the teacher does not know the learners, and the learners do not know one another. In larger classrooms where it is difficult to see all participants, it may be difficult to engage all the learners (3).
Strategies that increase student comfort, personal interpretation of content, and learning in large classrooms include in-lecture short methods, case studies, and in-class quizzes and tests. In-lecture innovations are quick, easy exercises or experiences that stimulate interest, build rapport, and reinforce concepts. While delivering information in a lecture format, the instructor can intersperse activities and ideas that grab the student's attention. (See Table 1.)
Case studies and scenarios are commonly used in nursing education. Rich clinical anecdotes, the drama of the human experience, and the practical nature of nursing knowledge all contribute to the value of this method. Case studies can be as brief or as extensive as time and abilities permit. Several types of cases are introduced in Table 2.
The in-class quizzes and test questions in Table 3 are important for reinforcing content. Students themselves, especially seniors facing the NCLEX exam, often request test items to be discussed in class. They are useful for testing knowledge, gaining a glimpse into test formats and content, and identifying learning needs.
The instructor should caution the class to wait for a signal before giving the answer. Students who are slower readers or need to think about test options find it frustrating to have peers answer a question before they find the answer.
These strategies may be implemented in large classrooms to enhance traditional lectures. Well-planned in-lecture innovations, case studies, and quizzes and test questions provide diversion, opportunities to assess student learning, tools to serve as memory builders, and reinforcement of key concepts.
Small Classes The definition of a small class varies with the environment. In some academic settings, a small class consists of no more than 10 students. In others, classes with fewer than 50 students are considered small. Generally, small groups of 20 to 30 students offer a great number of teaching advantages.
Working with a small group can be an enjoyable and effective teaching experience. By engaging learners and employing cooperative learning and problem-based techniques, teachers may perceive that they are in the most fertile ground for educational enhancements (4). However, challenges remain. Some students are reluctant to participate even in smaller groups, and the dynamics of the group may present some negative aspects.
While a cohesive group may encourage active learning, the dynamics of some groups discourage participation and the spirit of inquiry. A teacher who is able to assess group attitudes and needs can enhance group function through the use of learning interventions such as the ice-breakers, group exercises, and cooperative activities found in Table 4.
Teaching nursing research and scholarly appreciation is frequently a challenge for nurse educators. The need to make research understandable, relevant, useful, and enjoyable is necessary to develop future nurse scientists and enhance nursing care and client outcomes. Whether taught as a separate course or incorporated throughout the curriculum, research concepts are often taught in smaller groups. Several methods that may enhance learning are listed in Table 5.
Clinical Teaching Clinical teaching is undoubtedly one of the most rewarding venues in nursing education. It also offers significant challenges due to the intensity of the environment, the potential for large clinical groups, and the varying needs of students. Instructors grapple with the balance between teaching students and providing valid evaluation. Fostering independence in students is always tempered by the need to maintain control and organization within the group.
Several strategies can enhance clinicals and postconferences to create valuable learning experiences. The innovative strategies and enjoyable learning experiences in Table 6 can help both students and faculty balance the stress and frustration associated with clinical instruction (5). Teaching critical thinking, priority setting, and the application of theory are integral to nursing education. Ultimately, the clinical setting is where the practice of nursing is learned, and novice nurses grow and develop.
The Pros and Cons Creativity interfaces with content and the teacher's knowledge when ingenuity and imagination are used to design teaching strategies. Innovation and humor can drive home points and enhance retention (6), and the use of cartoons, film clips, and carefully expressed anecdotes can help change the pace of the traditional lecture, place content on a human plane, and demonstrate to students an enjoyment of teaching and sharing (7,8).
There are, however, disadvantages as well as advantages to the use of these strategies. On the positive side, these strategies appeal to different learning styles, stimulate students to attend to information, and, by making concept connections, facilitate the transition from one topic to another. The disadvantages arise from the risk inherent in each strategy. Some student's may not understand the significance or application of content, some may misconstrue meanings, and others may consider methods childish. Methods may "crash and burn" if students feel ill prepared for the activity or prefer passive learning methods.
To enhance effectiveness, creative 60-second strategies should be dealt in appropriate doses, casually added to content, and not forced or overused. Using them involves preparation time and class time. It is best to start with a few methods and adapt them to one's personal teaching style. The activities offered in this article can serve as a springboard for the development of new exercises.
Like any other skill, integrating new teaching strategies into one's instructional style demands a willingness to take risks, stretch one's imagination, and practice. To enter a realm where learning is active, fun, and memorable, and encourage students to respond positively to the experience, educators may want to remember this quotation from William Butler Yeats, "Education is not the filling of a pail, but the lighting of a fire" (9, p. 35).
Key Words Clinical Teaching--Creative Teaching Strategies--Nursing Education--Student Learning
Why are you here? Open the class with the
question, "Why are you here?" Responses to this
question allow instructors to compare their own
goals with those of their learners and gear content
to student needs. Sharing of class plans sets boundaries
about what will and will not be covered and
Short clips Show movie segments, commercials,
or clips from television shows to reinforce concepts.
Health care shows offer positive and negative
portrayals of nursing, medicine, client perspectives,
and key issues. Popular videos bear poignant
messages for today's TV generation. Rapport is
enhanced and information retained when content
relates to the learner's frame of reference. Even
greeting cards and comic strips provide humorous
ways to emphasize key information.
Stories Lay, business, parenting, or news literature
can enhance the relevance of key concepts.
Children's books may be used to develop an
appreciation of the universal nature of health
care issues and priorities. Nurses and students
instinctively cling to "war stories" and clinical
anecdotes to capture attention and reinforce
information. Telling brief, current, and well-spaced
stories may entice learners to attend to
content and establish priorities. Several publications
provide rich anecdotes to augment nursing
What's the big deal? A common source of
frustration for many nursing students is setting
priorities and selecting initial, key nursing
actions. Many students are shocked to find that
all four options on a multiple choice exam represent
correct answers, with their role being to
delineate the most correct answer. Implement
this strategy by asking, "What's the big deal?"
after teaching a concept. Focus on clinical scenarios,
cultural and spiritual priorities, and personal
experiences by asking this question and
having students discuss priorities and the impact
of health problems on clients.
Jigsaw This strategy by Ulrich and Glendon (11)
allows several groups to function individually to
meet the large group role. Each group contributes
a piece to the completion of a puzzle.
Conclusions are posted or reported to the class
for collective learning. Small groups are asked to
accomplish a task, such as diagnosing a cluster of
client conditions, analyzing different legal case
studies, and teaching across the lifespan at different
developmental levels. The instructor circulates
among the groups and helps communicate
results to the entire class.
All things being equal Students are given three
assessments or conditions about a client and must
prioritize client needs based on the given data with
the caveat "all things being equal." Delineating priorities
in the face of several pieces of information is
useful for developing skills in taking multiple choice
tests and NCLEX.
When you think of this, think of that This is
essentially a matching exercise to be used immediately
after a brief lecture to reinforce and clarify
key concepts. Two columns of data are presented
on overheads or PowerPoint slides. Students must
match the left and right columns.
Current events Current news stories, both
local and broad in scope, provide a "real-world"
application of learned content. Students are accustomed
to discussing current events from grade
school on. A significant number of nursing issues
can be discussed within the context of world
affairs. This strategy reinforces the need for nursing
professionals to be cognizant of current issues.
Research moments / corners Integrating
nursing research into every nursing topic establishes
currency of knowledge and provides a mechanism
for students to see the integral nature of research.
Providing a research moment in every lecture
enhances interest and discussion. Posting appropriate
research on a bulletin board, kiosk, or website
may stimulate the spirit of inquiry by allowing for
immediate application to current topics.
Quickie cases These one-slide or overhead cases
provide real-world application of content without
taking up much time. Students are asked to consider
a case study with limited data. Quickie cases provide
a segue into new topics, reinforce complex
prototypes of conditions, and relate clinical cases to
Before-class case studies Many students do not
spend time preparing for class. Providing case studies
in student workbooks that students must read
and research in order to answer questions adds to
the value of time spent in class for clarifying concepts
and identifying potential test areas. These cases
appeal to those students who need to read,
write, and hear concepts to actively learn. Cases
published in texts for educators may be helpful for
generating ideas and formats (12).
Continuing case studies / unfolding case
studies Developed by Glendon and Ulrich (13,14),
unfolding cases can be used to stimulate large group
discussion. Cases are presented and questions discussed
in small groups. Additional information is
provided and discussions are generated concerning
new developments. Continuing cases can be distributed
throughout the lecture to reinforce each step
of the discussion, providing a creative way to
strengthen critical thinking.
IN-CLASS QUIZZES AND TEST QUESTIONS
Quizzes Administering unannounced quizzes
meets several goals. Students are given one point for
simply attending class, one point for a question on
preparatory readings, and one point for content discussed
In-class questions Showing test questions every
few minutes during a lecture enables students to
test their skills. Published test banks, nursing review
books, and questions in the text provide a ready
supply of test items that can be integrated into lecture
content. Computerized slide presentations
allow for the presentation of a question and highlighting
the correct answer, allowing for a realistic
simulation of computer testing.
Leap questions To increase critical thinking,
instructors can develop test questions that ask students
to go to the next level. Rather than simply
testing knowledge, in-class test questions should ask
students to leap to the next point, apply knowledge,
determine key interventions, and establish priorities.
Play it again, Sam Repeating in-class test questions
throughout the semester or from year to
year allows students to see what they have
learned. Using similar test questions demonstrates
previous learning, increases confidence, and provides
Using prompts or manipulatives People of
all ages learn visually. Using toys, common household
objects, clime store prizes, or health care
equipment can aid in retention.
What's the point? After presenting content or
a client case, students are asked, "What's the
point?" This simple question helps ground content
and emphasize priorities.
The right thing to do Students are given a case
for analyzing legal and ethical issues and asked,
"What is the right thing to do?" This strategy can
promote discussion of some of the common
sense aspects of nursing. Presented with a client
scenario, students may be asked to reflect on
common interventions and the common sense
orientation inherent in nursing care.
Twosies Students pair off to demonstrate facial
expressions, assess each other's shoes, or discuss
a topic. This allows for personal discussion, even
when the size of the entire group precludes personal
sharing. In one example, the student turns
to a neighbor and says "nice shirt," using several
vocal tones and gestures. This exercise reinforces
the importance of the nonverbal elements of
Admit tickets Students are asked to answer a
question, ask a question, or make a comment about
class and write it on a ticket. The instructor allows
only those students who have a ticket into the
classroom, reinforcing the need for personal
responsibility, class preparation, and active involvement.
This strategy requires the instructor to maintain
a strict policy in dealing with nonparticipants.
Some instructors reverse this strategy and require
a ticket to leave the class.
The same information Students are given a
case in class, unaware that two groups have two different
sets of information. Students discuss the case
and realize that they are dealing with information
from different perspectives. This exercise may be
used to reinforce principles of communication, culture,
Student-led seminars Students are asked to
lead small discussions. This common classroom
strategy provides reinforcement and another voice
while cultivating public speaking talents.
Let's be real By saying "Let's be real" after a theoretically
based discussion, information is framed
within the context of true nursing practice. Clinical
examples provide a mechanism for discussion. This
is an excellent opportunity to help students differentiate
between real-life health care issues and
those on TV and elsewhere.
The six hats This activity, developed by Gross
(15), cultivates decision-making, teamwork, and
empathy in participants. Each color hat represents
a different perspective of an issue and provides
a forum for discussion (red = feelings/emotions,
yellow = optimism, green = creativity, blue
= the global, rational perspective, black = pessimism,
and white = pure logic).
Think-pair-share / Teaching trios / Group
think Described by several authors, including
Ulrich and Glendon (11), this versatile method
works well with clinical groups and all class
sizes, allowing for full participation. A question
or issue is posed. Students are asked to contemplate
the issue, pair up, and share insights. If done
in Teaching Trios, one member moderates or
evaluates the process. Larger groups can work in
a mode called Group Think, in which problems
are solved using group process.
In-basket exercises The methods above can
be incorporated into "In-basket" exercises. Students
are given a task, a time frame, and a limited
amount of information. They solve the problem
using only the data presented. These exercises are
effective in developing group cohesiveness and as
early group activities.
Write to learn Writing frequent statements during
a lecture or small group activity will stimulate
thinking, engage learners, and enhance writing skills.
Students may be instructed to describe a clinical
experience in one sentence, summarize the key
point of a discussion, or react to a statement (16).
Imagine Teaching empathy to new nurses can be
a challenge. Asking students to imagine what it
would be like to live through an ordeal and use personal
imagery to describe the emotions evoked is a
valuable way to enhance sensitivity.
Games Any content can be put into the format of
a marketed game, an adapted game show, or a
home-made rendition. Keep in mind group size,
class objectives, and the volume of content. Games
may last 10 minutes or the entire class period, provide
for out-of-class study, or test for the acquisition
Icebreakers Small groups frequently require
some method of introducing participants. Instructors
may have students introduce each other or
seek out answers to the "Why are you here?" question.
An effective icebreaker is to have pairs of students
try to find four characteristics they have in
common and four differences. Discussions may follow
around which proved easier, and commonalities
How do you pick your shampoo? In a
larger group, students can be asked about the
decision-making process used to select a
brand of shampoo. Using the steps of the
research process, students correlate
research, decision-making, and the nursing
Mike's scale / Shoot the arrow / Measuring
head exercises using straight rulers,
thread, and elastic Froman and Edwards
(17) describe several methods to teach about
reliability and validity. These exercises illustrate
the differences between these concepts
and their relevance to the research process.
Readers are encouraged to look to this
source for further details.
Designing mock studies Students plan
and implement mock research studies in
which they reinforce concepts of the
research process, including protection of
human subjects, data collection and analysis,
and nursing implications.
Campus research Students survey peers
and other students to learn elements of tool
development, field research, observational
research, and data analysis.
Concept maps Visual maps of research
concepts and methods may be used to reinforce
the research process or for the critique
of individual studies (18).
Clinical application of findings To apply
findings, students are asked to find a nursing
research article that applies to personal clinical
practice. Emphasis is on the critique of the
study and on the ability to utilize study
results in nursing practice.
CLINICAL TEACHING STRATEGIES
One-minute care plan Prior to patient care, students
develop a short problem/nursing diagnosis list.
Goals and strategies are established. The students
use the plan to guide patient activities, organize their
care, and evaluate goal attainment. Students create
useful and realistic patient profiles based on the
Grand rounds Use one-minute care plans to conduct
bedside or room-side nursing rounds. In a private
setting, students present their clients, have discussions
with colleagues, and work through difficult
Field trips Trips to the grocery store, pharmacy, or
toy store may be used to teach concepts of wellness,
nutrition, development, or pharmacology. Wikstrom
documented using trips to an art gallery to teach
nursing concepts (19).
Clinical questioning The ability to question students
about their preparation and readiness for care,
learning in the clinical setting, and ability to think critically
is truly an art. Students frequently find this type
of questioning offensive. Instructors must develop
nurturing, yet valid, methods to assess and teach in
the clinical area (20,21).
Ah-hah journals Journaling is a common method
of supporting student reflection and learning. Ah-hah
journals require students to identify a critical event,
something they did not know before, had not thought
of, or found surprising. In the journal they identify this
"ah-hah" describe the details and setting, pinpoint the
thoughts and feelings that accompanied the event, and
generalize learned concepts to future situations.
Using ah-hah journals helps steer students away from
chronological, nonreflective journal writing.
V-8 postconferences Much like ah-hah journals, V-8
conferences serve as a forum for discussing newly
learned concepts, ideas, or surprises in the clinical
setting. Students learn vicariously from one another.
Student-led discussions Students asked to lead
pre- or postconferences often come up with creative
ways to present information. Whether as a case
study, procedure, or debate, students sensitive to
each others' needs after a long day of clinical can
make these conferences fun and informative.
Pass the problem This is a great postconference
activity for students new to care planning. Students
place the age, gender, background information, medical
diagnosis, and nursing diagnosis for a client at the
top of a paper. The paper is passed to the next students.
Each student is asked to add client goals and a
nursing strategy to the information. Passed around a
group of eight to 10, the activity facilitates the planning
of client care and associated written work.
Quick-write Much like write-to-learn in small
groups, students in postconference are asked to
quickly write their reactions to the day, to a proposed
dilemma, or a note to their client. These may
be kept private or shared with the group.
Active reading Students can be taught the value of
policies or procedures by reading a policy from the
text or agency prior to performing the skill in the
clinical area. The skill is carried our, and the experience
stimulates a postconference discussion. Students
who were not able to practice the skill can
learn from the experience of others.
Group concept mapping Concept mapping is a
common strategy to enhance thinking in individual
nursing students (18). Working in teams can lead to
mapping activities of complex topics, such as care of
the burn client, dehydration, and heart failure.
Debate Formal debate is not often used in postconference,
but providing the opportunity to prepare
for a debate encourages involvement in public
issues and exploration of the nursing role. Many real-world
topics would be relevant to any clinical setting.
Learn from each other More a philosophy than a
strategy, students are encouraged to capitalize on
the experiences of others to gain the most out of
clinicals. Active discussion, meeting each other's
clients, and assisting one another in providing care
not only increases the value of the clinical setting, but
also encourages teamwork and collegiality.
(1.) Skiba, D. J. (1997). Transforming nursing education to celebrate learning. Nursing and Health Care Perspectives, 18, 124-131.
(2.) Simplicio, J. S. C. (2000). Teaching classroom educators how to be more effective and creative teachers. Education, 120, 675-682.
(3.) Billings, D. M., & Halstead, J. A. (1998). Teaching in nursing: A guide for faculty. Philadelphia: Saunders.
(4.) Irwin, S. M. (1996). Creative teaching strategies. Journal of Continuing Education in Nursing, 27, 108-114.
(5.) Herrman, J., Saunders, A., & Selekman, J. (1998). Beyond hospital walls: Educating pediatric nurses for the next millennium. Pediatric Nursing, 24, 96-99.
(6.) Paulson, T. L. (1989). Making humor work: Take your job seriously and yourself lightly. Los Altos, CA: Crisp.
(7.) Lundin, S. C., Paul, H., & Christensen, J. (2000). Fish: A remarkable way to boost morale and improve results. New York: Hyperion.
(8.) Beitz, J. M. (1999). Keeping them in stitches: Humor in perioperative education. Seminars in Perioperative Nursing, 8(2), 71-79.
(9.) Sullivan, B. (1996). Teachers: A tribute. Kansas City, MO: Andrews and McMeel.
(10.) Johnson, S., & Johnson, C. (1986). The one minute teacher; How to teach others to teach themselves. New York: Quill.
(11.) Ulrich, D. L., & Glendon, K. J. (1999). Interactive group learning: Strategies for nurse educators. New York: Springer.
(12.) Castillo, S. (1999). Strategies, techniques, and approaches to thinking: Case studies in clinical nursing. Philadelphia: Sounders.
(13.) Glendon, K., & Ulrich, D. L. (1997). Unfolding cases: An experiential learning model. Nurse Educator, 22(4), 15-18.
(14.) Glendon, K., & Ulrich, D. L (2001). Unfolding cases: Experiencing the realities of clinical nursing practice. Upper Saddle River, NJ: Prentice Hall.
(15.) Gross, R. (1991). Peak learning. New York: Tharcher/Putnam.
(16.) Lashley, M., & Wittstadt, R. (1993). Writing across the curriculum: An integrated curricular approach to developing critical thinking through writing. Journal of Nursing Education, 32, 422-424.
(17.) Froman, R. D., & Owens, S. V. (1991). Teaching reliability and validity: Fun with classroom application. Journal of Continuing Education in Nursing, 22, 88-94.
(18.) Rooda, L. A. (1994). Effects of mind mapping on student achievement in a nursing research course. Nurse Educator, 19, 25-27.
(19.) Wikstrom, B. M. (2000). Nursing education at an art gallery. Journal of Nursing Scholarship, 32(2), 197-204.
(20.) Ironside, P. M. (1999). Thinking in nursing education Part I: A student's experience. Nursing and Health Care Perspectives, 20, 238-243.
(21.) Ironside, P. M. (1999). Thinking in nursing education Part II: A teacher's experience. Nursing and Health Care Perspectives, 20, 243-250.
Judith W. Herrman, MS, AN, a doctoral candidate at the School of Urban Affairs and Public Policy, University of Delaware, is undergraduate clinical coordinator, Department of Nursing, University of Delaware, Newark. Special thanks are extended to Kathleen A. Schell, DNSc, AN, for her review of the manuscript.
COPYRIGHT 2002 National League for Nursing, Inc.