Education Interventions to Pass NCLEX

  1. I am curious what other educators are doing specifically to prepare students to pass the NCLEX. There seems to be some conflict regarding whether the BSN faculty want to teach students to critically think or pass NCLEX. To me, what's the difference? If they critically think, they should pass the NCLEX and vice versa. There are so many test banks out there to prepare students to take the NCLEX and was wondering which ones you have reviewed and preferred? I have found some questions online for free and have brought them into class and asked the students too. They love doing it as it makes them feel...well, I am right on target.

    The bottom line is that if they graduate with a BSN and fail the NCLEX, then they won't practice. I don't see how educators could not be concerned with their pass rates.

    I am most concerned that they are prepared to work on the floor and this is my greatest focus. Students love to learn psychomotor skills and if they don't feel comfortable with them, then they are unconfident in their delivery of care. I bring the critical thinking in with the skills as well along with developing their confidence level.

    Thanks for your input,
  2. Visit barb4575 profile page

    About barb4575

    Joined: Dec '00; Posts: 179; Likes: 23


  3. by   barb4575
    that no one has replied to this thread....I wish someone would...thank you! I could use some assistance. From what my students have told me they can't seem to get faculty interested in the topic...wonder why? Perhaps the low pass rate has something to do with it or it takes too much effort or what else?

  4. by   LadyT618
    Hi Barb,

    I'm an ADN student and I would have to agree with you with the correlation between low pass rates and a disinterest in the topic of NCLEX review. I know the professors at my school just discovered a couple of weeks ago (mind you this is my first semester) that it would be a good idea to set aside quality time to go over some NCLEX style review questions for our exams that we have in class.

    I feel this is something that all schools should do, from the beginning of the semester. Hey, maybe that can even make it some type of mandatory class that all students should take. Although, personally I don't feel the review sessions we've been getting are all that helpful (it could be the way they are handled). However, another student may find them extremely helpful.

    As for tips on how to review, I guess you can have students buy one book each so you have a wide variety of questions to ask. I know my professor suggested that to us for study groups.

    I also think it is very important that you mix both psychomotor and critical thinking skills. Both are equally important and depend on one another, in my opinion.

  5. by   barb4575

    I appreciate your comments and I do know a student who has passed the NCLEX who has many resources....she is going to place them in the office for other students to use. I do use Practice Questions in the beginning of class for my higher level course .... I get them online from Delmar and Kaplan. The students seem to like doing this too. So, perhaps I need to do this with Foundations students too.

    I always wonder what people mean when they say they are taking a test with NCLEX-type questions...I think as long as the faculty utilizes Bloom's Taxonomy and provides questions that are at the Analysis and Application levels, we should be providing NCLEX-type questions. One of my students said that her final consisted of NCLEX-type questions and she said it was extremely difficult. I am asking the professor for a copy of that exam to evaluate it.

    As in the real world of education, it is my students who assist me the most often...thank you for your assistance!

  6. by   LadyT618
    No problem, glad to be of help! Let me know how those questions (from the final) are.

    Talk to ya.

  7. by   indie
    In my school we revamped all our examinations to be in the form of NCLEX style questions. It took a few years to get to that point, but it did help our students by their own reports.

    Writing NCLEX style questions is a skill in itself - I had been an 'item writer' in another state and was also used to teaching part time for Kaplan, so I gave a workshop on how to write appropriate questions - this needed DON support and some staff were against it at first. I was also surprised at the low level of educational knowledge of the instructors - things like Bloom's taxonomy were new to so many. Eventually, with DON support, we gave workshops/CEUs for staff in these areas too.

    Schools with 'low' pass rates do not continue to receive BoN approval for the program; this is one thing the BoN monitors well because they are a consumer advocate agency and the students, to some extent, are consumers of what the school purports to offer. So I question the issues over 'low' pass rates. How does your school compare to the average in your state, or nationwide?

    When pushed by students to recommend an NCLEX style question book I would suggest the National Student Nurses' Association book - it seemed closest to what I knew about NCLEX questions.

    I do think it is very important to dispel the myths about NCLEX-RN (CAT) for students. Hold a fact session about the test with exact details on how a student is determined to pass or fail (this is complex - best illustrated by a graph with a hurdle on it, I believe), about the time issues involved and the mandatory break and optional break.

    Remind them to take water and possibly a snack and to take a test run to be sure they know how to get there and where to park etc. Do reinforce, 'while the computer is running, you still have a chance to show you can pass the test. Keep on.' I've had students take five hours and get thru nearly all the questions and still pass. Or had students failed with a shut off at 75.

    Remind students that the first questions are for practice, but they run into the real test with no clear break. Tell them that if a question just reads in a weird manner, to make a choice and move on (it is just possible that question is not part of the test, but is itself being 'tested'.

    Warn students that the test center may not have ideal conditions e.g. some students of mine took NCLEX with road works and drills outside the window or noise in the test center.

    Otherwise I just taught good nursing care, did not get into expert care scenarios with students as NCLEX tests a new graduate, not a critical care RN, critical thinking skills (e.g. we all know that to prevent osteoporosis, regular weight bearing exercise on the long bones is a good idea - make sure they can translate these sort of stylized responses into real life and realize this includes dancing, safe weight lifting.) I was surprised at the number of students who could trot out the text book statements, but did not know what these statements really meant in practice.

    Hope this helps.
  8. by   TSELBER
    i recently passed the NCLEX RN i used the Saunders NCLEX review i found it very helpful.
  9. by   barb4575
    I just tried to check on how my college rates with the state of IL, but I cannot find the information. At this school, it seems to be a secret what the pass rates are...I recently asked the Dean who stated it was 84%...which is the exact pass rate of the last BSN program where I had taught, but did go up during my time there. Could you direct me to a site that would inform me how this number compares to other nursing schools? I had not thought of doing that until you mentioned it here so thank you. I merely was not pleased with the number and decided something proactive must be done.

    I was also wanting to ask you if you had learned how to write questions for tests in graduate school? We had to do this in exercises and identify which of Bloom's taxonomy we were testing. I learned a great deal from those exercises. Also, several years ago, I had discussed test item writing with another faculty member who wrote questions for NCLEX. When I reviewed some of her questions, I did not see that it was critical thinking that was being tested...many were at the knowledge level. So, I am confused about what exactly writing questions like NCLEX me, it would be testing at the application or analysis level of Bloom's taxonomy.

    I appreciate your assistance,

  10. by   Tim-GNP
    I can't remember... I think it was in the most recent issue of Nursing Education-- there was a fairly well done study that discussed preparation for NCLEX. I can't remember the entire content of the article, but it was pretty good. If your school subscribes, check it out.
  11. by   SteelTownRN
    Here are some of the things that I've done in class and clinical to foster critical thinking/NCLEX success:

    1. 5 multiple choice questions at the end of a lecture. Review them with the students. Talk about how to reason through each question.

    2. Advocate buying an NCLEX review book during the first semester of clinicals and using it throughout clinicals, not just at the end of the program.

    3. Test review for the entire class is immediate. Students can silently look at a copy of the test taped down to a table in the back of the room, as they finish they can go back and look. Immediate test review helps them to learn from their mistakes. I require students who fail exams to do a 1:1 review with me in my office within a week of the exam. Not as punishment, but to pinpoint their weaknesses before the next exam.

    4. After AM report, I ask each student individually to rank the patients in priority order (ie who needs them the most according to what they heard in report). I also ask them to list nursing diagnoses for each patient that they heard about in report.

    5. My clinical group has a "drug of the day" discussion in post conference once a week. I tell them the name of an OB drug, and they have to look it up during their shift and memorize whatever they can about the drug. In postconference, they each must tell a fact about the drug, but not repeat what another student said.

    Hope some of these ideas work for others!
  12. by   barb4575
    I am printing out all of your replies and they are excellent and helpful strategies. SteelTown...I love the idea of giving five MC review questions at the end of the you do this in written form or verbally? I do some of the other things that you mentioned already, but it is helpful to be reminded as well.

    Happy New Year,

  13. by   GN2RN
    I must say I like your approach. I bet it proved to be very beneficial for your students.I sure could have used an instructor with your style of educating when I was in nursing school.

    I would like to see more emphases directed towards the preparation for the skills needed to become successful when sitting for state boards. This needs to take place from the very begining and throughout the students educational experience. Gaining the knowledge of the nursing curriculum along with the application of that knowledge in any given situation, nomatter how simple or complex it presents, is the basis for which we can build our critical thinking skills.

    I love the idea of prioritizing the clients based on report. The more you do the better you become at recagnising what takes priority over what. Very important.
    You have to know, what is the question asking me? break it down. exercise your thought process, reason it down. The more you do the better at it you become.If the nursing program i attended prepared me my utilizing these simple but so crucial study skills,I would have been well prepared for state boards. Keep up your great work

    Please excuse my spelling and grammer but this leasure time for me
  14. by   VickyRN
    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

    TABLE 1.


    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
    clarifies expectations.

    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
    content (6,7,10).

    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.

    TABLE 2.


    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
    didactic content.

    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.

    TABLE 3.

    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.

    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

    TABLE 4.


    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,
    and caring.

    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
    of knowledge.

    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
    among students.

    TABLE 5.


    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.

    TABLE 6.


    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
    nursing process.

    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
    patient issues.

    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.

    Last edit by VickyRN on Jul 3, '04