The Impact of Technology on the Content and Nature
of Teaching and Learning

Patricia A. Edwards, Ed.D., RN, CNAA
Excelsior College
Albany, NY

Co-Investigators:
Linnea Jatulis, Ph.D., RN & Mitchell S. Nesler, Ph.D.

This pilot study will examine student learning styles and motivation and their relation to outcomes in two online courses in a graduate nursing program. Findings from this research will expand the body of knowledge about how individuals learn and which technologies might be better suited to specific learning activities. Information obtained about the two online courses will allow faculty to develop patterns of teaching and learning that extend over the entire curriculum. Results will be shared with other Web-based programs to encourage further development of educational strategies for using technology to impact teaching and learning. The grant focuses on the following NLN Priority for Research in Nursing Education: the infusion of technology into the concepts, structures, and processes of nursing education.

Community-based Nursing Education:
Settings Used and Supervision of Pre-licensure Students

Betsy Frank, Ph.D., RN
Indiana State University
Terre Haute, IN

Co-Investigators:
Marsha Adams, D.S.N., RN & Jan Edelstein, Ed.D., RN-CS & Elizabeth Speakman, Ed.D., RN

The purposes of this study are (a) to describe what community-based settings are being used by associate degree and baccalaureate programs, (b) to explore whether or not the settings used for associate degree and baccalaureate degree programs are different from one another, (c) to describe how faculties provide for supervision of pre-licensure students in community-based settings, and (d) to synthesize from the findings best practices for community-based nursing education. The goal of this project is to survey accredited associate degree and baccalaureate degree programs no later than Fall 2002. We will be developing the survey during the Spring semester 2002 and using Web-based technology to administer it. Any nurse educator who would like to contribute to the content of the survey is invited to contact Betsy Frank via email at: Betsy-Frank@indstate.edu

Is Scholarly Identity Development an Outcome
of a Transformative Learning Environment?:
Initiating A Research-Based Curriculum

Kathleen T. Heinrich, Ph.D., RN
University of Hartford
Hartford, CT

Co-Investigators:
Georg'Ann Bona BSN, RN & Michele McKelvey BSN, RN & Sheila Solernou BSN, RN

Bunkers (2000) called for educators to prepare nurse scholars for the new millennium. This is a formidable challenge given that we are just beginning to understand how to foster scholarly identity development in the mid-life women who predominate nursing.

In the last twelve years of studying scholarly identity development, I have learned that mid-life women's scholarly identity development involves a "perspective transformation" (Mezirow, 1990; Maltby & Andrusyszyn, 1997) that begins with the dream of doctoral study and takes five years after doctoral study to fully internalize (Heinrich, under review). Given that this developmental process unfolds over a number of years, I am convinced that mid-life women's, scholarly identity development needs to be initiated at the master's level. Simultaneously a curricular innovation and an evaluation research project -- the proposed, collaborative project -- engages University of Hartford (UH), graduate nursing faculty, student-partners, and students in offering and evaluating an introductory course entitled "Perspective Transformation I" during the 2001-2002, academic year. This course is designed to create a transformative learning environment that nurtures the scholarly identity development of a cohort of newly-matriculated, master's students' within a community of scholarly caring.

This project is most closely aligned with the following NLN Priority for Research in Nursing Education: research-based paradigms, strategies, and evaluation models for nursing education. The findings will hopefully have implications for best practices for teaching and learning and suggest new pedagogies for nursing education that foster scholarly identity development in master's-level,
nursing students. They also would be expected to support reform and innovation (of strategies for evaluation that ground curricular experiences) in schools of nursing.

Using the Self-regulated Learning Model to
Promote Reflective Practice in
Senior Level Baccalaureate Nursing Students

RuthAnne Kuiper, Ph.D., RN
Winston-Salem State University
Winston-Salem, NC

This study will address the following NLN Priorities for Research in Nursing Education: (a) competencies of nursing graduates for 21st century practice and (b) research-based paradigms, strategies, and evaluation models for nursing education. The significance to nursing education is for the development of competent nursing graduates. Specifically, the significant problem is how to promote metacognitive critical thinking processes for problem solving in clinical situations as new graduates transition from graduating nurse to practicing nurse.

The major premise of this study is that educational outcomes can be achieved by promoting self-regulation strategies that improve metacognitive critical thinking abilities in novices. Specifically, it is designed to document whether guided reflection facilitates and remodels metacognitive thought over time.

The aim of this project is to describe the effects of self-regulated learning prompts on the cognitive processes of senior level baccalaureate nursing students as they reflect on clinical experiences using a hand-held tape recorder. It is hypothesized that recording actions and reactions will stimulate students to reflect on their experiences, identify dissonance, and move toward remodeling metacognitive thought over time. It is hoped that this application research, which is based on current theories from the constructivist paradigm, will be a means to build a theoretical foundation for pedagogical strategies that will aid in the development of cognitively-prepared practitioners.

Service-Learning Across a Nursing Curriculum:
Improving the Health of a Community and Enhancing Student Learning

Deanna L. Reising, PhD, RN, CS
Indiana University
Bloomington, IN

Co-Investigators:
Roberta A. Shea, MSN, RN, CNS & Patricia N. Allen, MSN, RN, NP

Nursing schools are well positioned to effect positive health outcomes in the community; yet, the contribution of nursing to the health of the community may not be fully realized. While many schools of nursing require their students to complete health projects of benefit to the community, projects often are confined to a single course within a semester, with no overall comprehensive community program plan. The drawbacks to semester-length projects are that there is a lack of follow through in meeting community needs and a lack of measurement strategies to determine whether long term outcomes have been achieved. The purpose of this study is to evaluate the impact of a service-learning program, conducted over the course of four semesters, on community health care outcomes and student learning. The research questions are: (1) What is the impact of service-programs on the health of the community?, and (2) What is the effectiveness of service-learning programs as a method to achieve program outcomes? The NLN Priorities for Research in Nursing Education with which this project is most closely aligned are the following: research-based paradigms, strategies, and evaluation models for nursing education; and accountability links between educational programs and health outcomes.

Simulation in Critical Decision-Making: Training the Trainers

Mary Karlet, Ph.D., CRNA
Duke University
Durham, NC

Co-Investigators:
Midge Bowers, M.S.N., FNP & James Temo, M.S.N., MBA, CRNA

Rural clinical preceptors spend lengthy and intense periods of time with student learners providing patient care, yet the qualities and skills that facilitate effective student learning are not necessarily part of the clinician's armamentarium. The "Simulation in Critical Decision-Making: Training the Trainers" grant will investigate whether participation in simulated instructor-student case scenarios, using the Human Patient Simulatorä (HPS), (Medical Education Technologies, Inc.), improves the rural clinician's preceptoring skills.

Utilizing HPS technology, the study will evaluate how preceptors respond to clinical scenarios in a controlled environment and will determine whether simulation training builds and strengthens effective teaching methods. The study is consistent with the following NLN Priority for Research in Nursing Education: educator competencies for changing social, health care, and educational worlds. Patient care simulation activities may benefit the rural preceptor by providing and reinforcing the information, skills, and attitudes necessary to transition from a clinician to an educator role.

Using the Human Patient Simulator to Enact Learning Scenarios
for Crisis Intervention and Critical Incident Debriefing:
A Comparative Study of Learning Techniques

Carol B. Stewart, M.S., RN, CS, CADC
College of DuPage
Glen Ellyn, IL

Co-Investigators:
Rita Bobrowski, Psy,D., MS, RN & Ken Bretl, M.A., RRT & Sheila Vaughn, B.S.N., RN

Can the Human Patient Simulator be effective as a learning strategy to develop nursing skills in crisis intervention and critical incident debriefing? Will student nurses trained in this model have a better understanding of how to address the potential and real medical crises that occur when a client has a primary illness, as well as manage the effects these crises can have on the client, significant others and the health care team? How does this learning strategy compare to other traditional learning strategies with the same goal? The study entitled Using the Human Patient Simulator to Enact Learning Scenarios for Crisis Intervention and Critical Incident Debriefing: A Comparative Study of Learning Techniques is designed to examine these questions.

The College of DuPage Associate Degree Nursing Program has developed a powerful scenario that utilizes the Human Patient Simulator in the mental health nursing curriculum. The student is placed in a position to stabilize a client with a medical emergency related to a primary mental health diagnosis, and at the same time, help crisis witnesses to begin their own recovery.

NOTE: Although this project was approved in the 2001 grants cycle, it will not be initiated until the
Fall of 2002.

Use of the Human Patient Simulator to Enhance Clinical Decision-
Making Skills of Associate Degree Nursing Students

Gloria Goldman, PhD, RN
Sinclair Community College
Department of Nursing
Dayton, OH

Co-Investigators:
Wanda Jelus, MS, RN & Kathleen Mills, MS, RN

The purpose of this study id to determine the effect of learning experiences with the Human Patient Simulator (HPS) on clinical decision-making by senior associate degree nursing students enrolled in a critical care nursing course. Investigators will use a quasi-experimental method to compare performance of students who were engaged in traditional classroom learning activities with performance of students who participated in learning activities with the HPS. Care of the person in shock has been selected as an exemplar.

Enhancing the Baccalaureate Maternal-Newborn and Pediatric
Nursing Courses: A Pilot Study of Scenario Testing

Wendy M. Nehring, PhD, RN
Southern Illinois University at Edwardsville
School of Nursing
Edwardsville, IL

Co-Investigators:
Laura Bernaix, PhD, RN & Cynthia Schmidt, PhD, RN & Wayne Ellis, PhD, RN, CRNA &
Rita Wunderlich, MS, RN & Bernadette Henrichs, PhD, RN

Human patient simulators (HPSs) can be effectively used to objectively assess the critical thinking, knowledge level, and technical skills of undergraduate nursing students. The purpose of this study is to clinically validate the efficacy of four patient scenarios using the HPS with junior level nursing students. Scenarios on abruptio placenta previa and on pre-term labor will be developed for the pediatric nursing course. The pediatric HPS will be used for these scenarios.

It is hypothesized that: (a) the level of knowledge concerning each of these health conditions will be increased after instruction using the HPS, and (b) this level of knowledge will remain higher than the knowledge level prior to instruction one week after instruction. An untreated control group design with pre-test and post-test will be used.

Approximately 157 students will participate in this study across two semesters. In an effort to assist with the accuracy and comprehensiveness of the scenarios, an advisory board to the Human Patient Simulator Program will be identified and formed.

Brain-based Learning Principals applied to the Teaching of Basic Cardiac Code
to Associate Degree Nursing Students Using the Human Patient Simulator

Jean M. Wortock, MSN, APRN
St. Petersburg College
St. Petersburg, FL

Co-Investigators:
Jodi Parks-Doyle, EdD, RN & Gail Burt, MSN, RN

The educational focus is shifting from teaching strategies to student learning. Advances in brain research have enabled improved understanding of both brain functioning and learning. Brain Based Learning (BBL) principles encompass the following: learning is physiological - brain structures or dendrites grow during learning; dendrites grow with practice, and with activity. Nursing students need to construct basic, foundational dendrites before higher level structures can be formulated. Higher-level brain structures are needed for critical thinking. In addition, simulations have been known to assist in learning. With the recent advent of the Medical Education Technologies, Incorporated (METI) computer driven Human Patient Simulator, much more sophisticated simulations are possible.

There will be four groups of subjects (N=180) who will be randomly assigned to treatment groups: (1) standard code instruction, (2) the human simulator instruction, (3) the BBL module on basic cardiac code, or (4) a combination of the BBL module and the Human Patient Simulator. By combining the principles of brain-based learning to the teaching of basic cardiac code of nursing students in an Associate Degree Nursing Program utilizing the Human Patient Simulator (HPS), it is projected that critical thinking will be enhanced. Critical thinking will be measured with the Educational Resources, Inc. "Critical Thinking Process Test."

This quantitative study will use a classic pre-test post-test experimental design employing random assignment. The data will be analyzed using a 2X2 factorial ANOVA. This two-way analysis of variance permits the investigation of both the separate and joint effects of two independent variables on a dependent variable. The two independent variables are the Brain-Based Learning (BBL) module and the Human Patient Simulator (HPS). These two variables are hypothesized to act in conjunction with one another to exert a joint influence. The dependent variable will be critical thinking. The joint effects of the two independent variables on the dependent variable will be studied through the analysis of main effects and interaction effects in the context of factorial design.

Reflections on the Role of Faculty in Distance
Learning and Changing Pedagogies

Kay Hodson-Carlton, EdD, RN, FAAN
Ball State University
Muncie, IN

Co-Investigators:
Marilyn Ryan, EdD, RN & Nagia Ali, PhD

The phenomenon of technology-based education has raised significant questions surrounding the role and perceptions of faculty teaching on the Internet, such as "What constitutes teaching/learning?" The study has three aims: (a) to describe experiences of faculty teaching total electronic nursing courses, focusing on faculty role, pedagogies, and lessons learned, (b) to develop a questionnaire based on qualitative data, and (c) to conduct a national survey of faculty in Schools of Nursing teaching electronic courses to determine the changing role of faculty, new pedagogies, and lessons learned. This study builds on the work of Diekelmann, Schuster and Nosek (1997) that examined the common experiences of teachers using distance education technologies in a qualitative study. This study is significant because traditional faculty roles are changing. New roles must be defined and communicated to the current and future academic community in nursing and other disciplines. This project related to the specific research priority of the next generation of nursing faculty.

Predictors and Interventions for NCLEX-RN Success in
Baccalaureate Nursing Programs: A National Survey

Carolyn S. Crow, PhD, RN
The University of Alabama
Tuscaloosa, AL

Co-Investigators:
Marilyn Handley, MSN, RN & Ruby Morrison, DSN, RN & M. Mitch Shelton, PhD, RN

In response to the changing health care needs of the public, many BSN programs have developed and implemented major curriculum changes. Concurrently, changes in the NCLEX-RN test plan and passing score have resulted in lower than unusual NCLEX-RN pass rates for many schools. The purposes of this study are to (a) determine the best predictors of NCLEX-RN success among graduates of BSN programs, and (b) identify specific program requirements and educational interventions that influence NCLEX-RN success among graduates of BSN programs. The study design will be descriptive correlational using a survey method for data collection. Participants will be recruited from the 513 generic BSN programs listed in the National League for Nursing's (NLN) Official Guide to Undergraduate and Graduate Nursing Schools. The study will address the NLN Blue Ribbon Panel's Nursing Educational Research Priority on "competence of nursing graduates for 21st century practice."

Evaluation of Epistemological and Ethical Maturity
in Baccalaureate Nursing Students

Bronwynne C. Evans, PhD, RN
Washington State University
Intercollegiate Center for Nursing Education
Spokane, WA

Focus of the Study: The purpose of this study is to measure cognitive development in baccalaureate nursing students through a paper-and-pencil production task instrument, the Measure of Intellectual Development (MID), and a paper-and-pencil tool, the California Critical thinking Disposition Inventory (CCTDI). The study will asses (a) overall program outcomes and (b) outcomes of a nursing class (N398, Concepts of Caring) using narrative pedagogy in the context of a caring community, rather than with traditional class methods. Using these two instruments in tandem, data will be analyzed according to the following parameters: compare pre- (entering) and post- (graduation) scores for all entering students taking the N398 class at any time during their tenure at the ICNE and compare them with students who have not taken the class by the time of graduation; compare beginning N398 scores with completing N398 scores for each semester; compare beginning N398 scores with completing N398 scores for each semester; compare completing N398 scores from each semester; and compare completing N398 scores with graduation scores on both instruments.

Significance to Nursing Education: Cognitive and ethnical maturity in graduate nurses influences their ability to make independent, effective decisions in the ambiguous, problematic world of clinical practice (Valiga, 1983; Benner, 1984; Schon, 1991). This vital decision-making ability includes critical thinking, priority setting, and deep understanding of unique client situations, but it is unavailable to nurses who operate at less mature levels where fact- and rule-driven behavior predominates. Because changes in the health care system mandate the education of nurses who can engage in such autonomous, cost-effectiveness practice, educators must be increasingly attentive to issues of cognitive and ethnical development.

Relationship to NLN Research Priority: This project responds to the Priority on "research-based paradigms, strategies, and evaluation models for nursing education" through outcomes evaluation of an innovative teaching model. It could provide information leading to the identification of a "best practice" in nursing education and potential instructional reform.

Developing A Research Base for Nursing Education:
Implementing and Evaluating Narrative Pedagogy
in an Introductory Nursing Course
Using a Multi-Method Approach: A Pilot Study

Pam M. Ironside, PhD, RN
Clarke College
Dubuque, IA

Increasing diversity in student populations, diminishing resources, and faculty reductions across higher education have prompted calls for educational reform through developing new pedagogies. These calls have resulted in a renewed commitment to innovative teaching and learning strategies, and serious scholarship has been devoted to exploring alternatives to conventional approaches to education. The literature in nursing and higher education is replete with descriptions of alternative pedagogical approaches to schooling (critical, feminist, and phenomenological) that are claimed to be responsive to this changing educational milieu. These new pedagogies offer new ways of thinking about and using current approaches such that the taken-for-granted practices, strategies, and assumptions of teaching and learning are challenged, critiqued, and deconstructed. There are very few studies in either higher or nursing education, however, that evaluate these pedagogies in actual classroom situations. In order to develop a research base for nursing education, multi-method studies are needed to systematically evaluate new pedagogies in the context of contemporary nursing education. This is a pilot study that uses an alternative pedagogy, Narrative Pedagogy, in redesigning a nursing course and uses a multi-method approach to evaluate the implementation of this pedagogy.

Technology vs. Traditional: A Comparison of Two Instructional Methods
to Teach the Skill of Performing a 12-lead ECG

Pamela R. Jeffries, DNS, RN
Indiana University
Indianapolis, IN

The purpose of this study is to compare the effectiveness of an interactive, multimedia CD-ROM embedded with virtual reality and traditional laboratory demonstration/class for teaching baccalaureate nursing students how to perform a 12-lead electrocardiogram (ECG). A randomized pretest-posttest experimental design is used. Seventy-five senior, baccalaureate nursing students enrolled in a required critical care course will be recruited for the study at a large midwestern university. The nursing students will be randomized into two groups of instruction: traditional and technology. Two methods will be compared for teaching how to perform a 12-lead ECG: a demonstration in the nursing laboratory and an interactive multimedia CD-ROM embedded with virtual reality program, covering the same content. A self-study module covering the principles of the procedure will be used with both groups. Outcomes being measured will include learner satisfaction and self-efficacy in learning between the two groups in addition to cognitive gains as measured by pre- and post-tests. Furthermore, skills acquisitions will be measured using a competency skills check-list and requiring the student to perform a 12-lead ECG on a human, simulated patient.

Clinical Outcomes Evaluation:
Operationalization of the NONPF Guidelines

Grace Newsome, EdD, RN, CS, FNP
North Georgia College and State University
Dahlonega, GA

Co-Investigator:
Marina Slemmons, PhD, RN, CPNP

The focus of this research is the development of valid and reliable clinical outcome evaluation tools for advances nursing practice. Tools which reflect the "Domains and Competencies of Nurse Practitioner Practice," as outlined by the National Organization of Nurse Practitioner Faculties (NONPF), will be developed. The initial stages of the research will include review of the literature related to clinical outcome evaluation in advanced nursing practice and, concurrently, a survey of nurses practitioner programs to determine the current use of NONPF's "Domains and Competencies" with a specific focus on clinical outcome evaluation. Using this initial information, a list of competency behaviors, including those currently utilized, will be developed. A Q-sort of behaviors to determine those which best reflect competent NP practice will be carried out by expert nurse practitioner faculty and preceptors. These selected behaviors will then be incorporated into the development of clinical outcome evaluation tools. Finally, tools will be piloted, revised and finalized based on findings.

Quality preparation of advanced practice nurses which can be supported through the documentation of clinical competence is needed. This research will help provide information related to current practices in clinical outcome evaluation and the extent to which NP programs utilize the current "Domains and Competencies of Nurse Practitioner Practice" and/or other competencies. It will also provide reliable and valid examples of instruments that document competency attainment.

The research is related to the NLN Priority on research-based paradigms, strategies and evaluation models for nursing education. It addresses the evaluation of teaching and learning outcomes with a focus on clinical evaluation.

The Teaching Style of Nursing Faculty as an Indicator for Creating Learning Environments that Contribute to Critical Thinking in Nursing Students

Karen Moore Schaefer, DNSc, RN
Temple University
Philadelphia, PA

Co-Investigator:
Dolores M. Zygmont, PhD, RN

The purpose of this study is to describe the teaching style of a group of nursing faculty as either teacher-centered or student-centered. This study is guided by the premise that certain teaching styles foster independence in learning, creative problem solving skills, and a commitment to life long learning.

In a teacher-centered approach, the students are passive recipients of information, and learning is said to have occurred only if a change in behavior is evident. Student-centered learning, on the other hand, focuses on the needs of the students rather than the knowledge to be transmitted. This approach is characterized by a collaborative relationship between the teacher and students where both are actively engaged in the content and process of learning. Students are encouraged to question, conjecture, and be creative in a student-centered approach. Environments that foster inquisitiveness and creative strategies are consistent with a student-centered teaching style that is essential in developing critical thinking skills.

A correlation design with method triangulation will be used to achieve the study goals. One hundred NLNAC-accredited schools will be randomly selected to invite five members of the faculty to participate in the study. Data will be collected using the Principles of Adult Learning Scale, demographic questionnaire, and instructional materials (submitted by 10 randomly selected faculty members). This data will be used to describe the teaching styles of the faculty members, demographics of faculty members, and their philosophy of and written approaches to teaching (instructional materials).

The findings of the qualitative and quantitative analysis will be discussed within the context of previously-published data to enhance, expand, and clarify current knowledge of teaching styles. It is expected that additional areas of research will be identified. This study is consistent with the National League for Nursing's Priority of developing educator competencies for changing social, health care, and educational worlds, with a direct relationship to the redefinition of faculty and student roles in learning paradigms.