Teaching EBP Column
Active Learning Strategies to Teach Undergraduate Nursing Statistics: Connecting Class and Clinical to Prepare Students for Evidence-Based Practice Amy Hagedorn Wonder, RN, PhD • Julie L. Otte, RN, PhD, OCN This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/ journal/10.1111/(ISSN)1741-6787
BACKGROUND Although the importance of education to achieve and sustain evidence-based practice (EBP) is widely recognized, many baccalaureate degree nursing programs throughout the United States continue to focus on teaching students how to conduct research instead of how to translate research and clinical data into evidence-based care (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). The misalignment between what the student is taught and what the nurse will need for EBP contributes to a persistent gap in the requisite knowledge, skills, and attitudes. To facilitate the knowledge and skills necessary for statistical thinking and literacy as well as an understanding for how evidence applies to practice, faculty need to consider what and how statistics is taught in prelicensure programs and embrace active learning strategies that use real data (Hayat, 2014). Teaching methods that focus on statistical concepts and application to practice can help undergraduate nursing students develop the critical thinking and statistical literacy skills they will need to be better consumers of evidence (Hayat, Eckardt, Higgins, Kim, & Schmiege, 2013). Through the use of current literature and active learning strategies that reflect real clinical scenarios, faculty can teach students to: (a) critically appraise analysis methods and findings in the context of quality and safety improvement, and (b) identify implications for nursing and the interprofessional team. Innovative strategies that enable teachers to facilitate understanding also can engender a positive attitude for statistics and ultimately EBP, which is key to students utilizing requisite skills for practice (Toole, Stichler, Ecoff, & Kath, 2013). The following approach illustrates how an active learning experience based on a real practice problem can engage students in the thinking necessary to understand how evidence and patient-related data can be
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used in conjunction with clinical expertise and patient or family values to directly influence care, treatment decisions, and outcomes.
DESCRIPTION OF ACTIVE LEARNING STRATEGY Learning exercises reflecting current nursing practices help faculty teach the utility of statistical processes and how that content links to research and practice outcomes. Because statistics can be intimidating, it is important to start with simple exercises and nonthreatening props (i.e., chocolate chip cookies) to help students gain confidence in their ability to learn the concepts needed to enact EBP. Although the use of chocolate chip cookies is not a novel idea (Baker, 2014; Lee, 2007), the application of this exercise to a realistic practice concern opens the door to new ways to help students understand analysis methods, how they are used in practice, and implications relative to quality and safety improvement.
Scenario Students are presented with the following case scenario via PowerPoint to start the active learning experience: You are working on a busy, 40-bed postsurgical unit in an acute care hospital. Lately, you have noticed an increase in the rate of nosocomial infections in general surgery patients. You bring your concern to your department-based Quality Council meeting. You and your colleagues discuss the need to collect and analyze the data for trends. The leader of the department-based Quality Council relays this information to the hospital-wide Quality Council and learns that the other 40-bed postsurgical unit has not recognized an increase in their infection rate. Nursing leaders decide to collect data from both postsurgical departments to determine
Worldviews on Evidence-Based Nursing, 2015; 12:2, 126–127. C 2015 Sigma Theta Tau International
Teaching EBP Column if there are statistically significant differences in the rates of a communal infection between the two units while also exploring the data for possible trends. As a staff nurse, you are involved in data collection and analysis.
Active Learning For this exercise, students work in small groups, although each person collects data individually. Each student is given two chocolate chip cookies (one brand A and one brand B). Students are instructed to count the number of whole chocolate chips in each of their two cookies. During the activity, students observe differences in how group members collect data. This generates spontaneous discussions on sampling methods, inclusion and exclusion criteria, bias, and data collection. An appointed leader enters each group’s data into a single dataset in the classroom, whereas overhead projection enables large group observation of data entry and analysis. Following test analysis, interactive discussions begin with why a t-test was the preferred statistical method and then advance to significance of findings and calculated risk for Type 1 error (falsely rejecting the null). Applying the results of the inclass analysis to the real world of practice via analogy stimulates discussion on how findings can influence practice, policy, and collaborative decision making among clinical experts, patients, and families. Although this case scenario is focused on testing the difference between two nursing units, small group or class discussions can explore other clinical applications of the ttest analysis method. For example, students can utilize more realistic data to analyze and explain how a t- test can be used to evaluate the differential effectiveness of care products (e.g., wound care supplies) or structures (educational resources) to impact outcomes for patients, nurses, and organizations.
METHODS TO EVALUATE OUTCOMES
abstract and complex applications. Students’ understanding was evident with a class average of greater than 90% on the comprehensive final course examination. WVN
LINKING EVIDENCE TO ACTION r Innovative teaching methods that focus on application of concepts to practice can enable the knowledge, skills, and attitudes needed to enact EBP.
r Active learning experiences can facilitate a progressive understanding of the statistical concepts essential for statistical literacy.
r Analogies that connect active learning exercises with clinical scenarios can help students understand statistical concepts and how evidence can influence care and outcomes.
Author information Amy Hagedorn Wonder, Indiana University, Nursing, Community and Health Systems, Bloomington, IN, USA; Julie L. Otte, Indiana University, Science of Nursing Care, Indianapolis, IN, USA. Address correspondence to Dr. Amy Hagedorn Wonder, Indiana University, Nursing, Community and Health Systems, 1033 E. Third Street, Sycamore Hall #408, Bloomington, IN 47405; [email protected] Accepted 5 September 2014 C 2015, Sigma Theta Tau International Copyright
References
To evaluate student understanding of the statistical concepts and the associated application to practice, faculty can challenge individuals and groups to develop other scenarios or to locate research reports that appropriately use the t- test to analyze other quality problems (e.g., patient falls, pressure ulcers). Student and group presentations provide a variety of practice examples while allowing faculty to gauge understanding. Homework and quizzes clearly aligned with the active learning objectives based on statistical output or published results are additional ways to gauge students’ understanding (Hayat, 2014).
Baker, A. (2014). Teaching quality control with chocolate chip cookies. Teaching Statistics, 36(1), 2–6.
RESULTS
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410-417.
Systematic evaluation of the effects of the learning experience is important. Initial feedback for the scenario used above was submitted by over 50% of the class at the end of the semester. The online survey provided quantitative and qualitative feedback with results suggesting that the active learning exercises and assignments had a positive impact on students’ academic and clinical development. Students reported that by beginning with simple exercises that allowed them to visualize and physically touch data, it enabled them to progress to more Worldviews on Evidence-Based Nursing, 2015; 12:2, 126–127. C 2015 Sigma Theta Tau International
Hayat, M. J. (2014). Guidelines for assessment and instruction in statistics education (GAISE): Extending GAISE into nursing education. Journal of Nursing Education, 53(4), 192– 198. Hayat, M. J., Eckardt, P., Higgins, M., Kim, M., & Schmiege, S. J. (2013). Teaching statistics to nursing students: An expert panel consensus. Journal of Nursing Education, 52(6), 330–334. Lee, K. H. L. (2007). Chocolate chip cookies as a teaching aid. The American Statistician, 61(4), 1–5.
Toole, B. M., Stichler, J. F., Ecoff, L., & Kath, L. (2013). Promoting nurses’ knowledge in evidence-based practice: Do educational methods matter? Journal for Nurses in Professional Development, 29(4), 173–181. doi 10.1111/wvn.12075 WVN 2015;12:126–127
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Active Learning Strategies to Teach Undergraduate Nursing Statistics: Connecting Class and Clinical to Prepare Students for Evidence-Based Practice Amy Hagedorn Wonder, RN, PhD • Julie L. Otte, RN, PhD, OCN This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/ journal/10.1111/(ISSN)1741-6787
BACKGROUND Although the importance of education to achieve and sustain evidence-based practice (EBP) is widely recognized, many baccalaureate degree nursing programs throughout the United States continue to focus on teaching students how to conduct research instead of how to translate research and clinical data into evidence-based care (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). The misalignment between what the student is taught and what the nurse will need for EBP contributes to a persistent gap in the requisite knowledge, skills, and attitudes. To facilitate the knowledge and skills necessary for statistical thinking and literacy as well as an understanding for how evidence applies to practice, faculty need to consider what and how statistics is taught in prelicensure programs and embrace active learning strategies that use real data (Hayat, 2014). Teaching methods that focus on statistical concepts and application to practice can help undergraduate nursing students develop the critical thinking and statistical literacy skills they will need to be better consumers of evidence (Hayat, Eckardt, Higgins, Kim, & Schmiege, 2013). Through the use of current literature and active learning strategies that reflect real clinical scenarios, faculty can teach students to: (a) critically appraise analysis methods and findings in the context of quality and safety improvement, and (b) identify implications for nursing and the interprofessional team. Innovative strategies that enable teachers to facilitate understanding also can engender a positive attitude for statistics and ultimately EBP, which is key to students utilizing requisite skills for practice (Toole, Stichler, Ecoff, & Kath, 2013). The following approach illustrates how an active learning experience based on a real practice problem can engage students in the thinking necessary to understand how evidence and patient-related data can be
126
used in conjunction with clinical expertise and patient or family values to directly influence care, treatment decisions, and outcomes.
DESCRIPTION OF ACTIVE LEARNING STRATEGY Learning exercises reflecting current nursing practices help faculty teach the utility of statistical processes and how that content links to research and practice outcomes. Because statistics can be intimidating, it is important to start with simple exercises and nonthreatening props (i.e., chocolate chip cookies) to help students gain confidence in their ability to learn the concepts needed to enact EBP. Although the use of chocolate chip cookies is not a novel idea (Baker, 2014; Lee, 2007), the application of this exercise to a realistic practice concern opens the door to new ways to help students understand analysis methods, how they are used in practice, and implications relative to quality and safety improvement.
Scenario Students are presented with the following case scenario via PowerPoint to start the active learning experience: You are working on a busy, 40-bed postsurgical unit in an acute care hospital. Lately, you have noticed an increase in the rate of nosocomial infections in general surgery patients. You bring your concern to your department-based Quality Council meeting. You and your colleagues discuss the need to collect and analyze the data for trends. The leader of the department-based Quality Council relays this information to the hospital-wide Quality Council and learns that the other 40-bed postsurgical unit has not recognized an increase in their infection rate. Nursing leaders decide to collect data from both postsurgical departments to determine
Worldviews on Evidence-Based Nursing, 2015; 12:2, 126–127. C 2015 Sigma Theta Tau International
Teaching EBP Column if there are statistically significant differences in the rates of a communal infection between the two units while also exploring the data for possible trends. As a staff nurse, you are involved in data collection and analysis.
Active Learning For this exercise, students work in small groups, although each person collects data individually. Each student is given two chocolate chip cookies (one brand A and one brand B). Students are instructed to count the number of whole chocolate chips in each of their two cookies. During the activity, students observe differences in how group members collect data. This generates spontaneous discussions on sampling methods, inclusion and exclusion criteria, bias, and data collection. An appointed leader enters each group’s data into a single dataset in the classroom, whereas overhead projection enables large group observation of data entry and analysis. Following test analysis, interactive discussions begin with why a t-test was the preferred statistical method and then advance to significance of findings and calculated risk for Type 1 error (falsely rejecting the null). Applying the results of the inclass analysis to the real world of practice via analogy stimulates discussion on how findings can influence practice, policy, and collaborative decision making among clinical experts, patients, and families. Although this case scenario is focused on testing the difference between two nursing units, small group or class discussions can explore other clinical applications of the ttest analysis method. For example, students can utilize more realistic data to analyze and explain how a t- test can be used to evaluate the differential effectiveness of care products (e.g., wound care supplies) or structures (educational resources) to impact outcomes for patients, nurses, and organizations.
METHODS TO EVALUATE OUTCOMES
abstract and complex applications. Students’ understanding was evident with a class average of greater than 90% on the comprehensive final course examination. WVN
LINKING EVIDENCE TO ACTION r Innovative teaching methods that focus on application of concepts to practice can enable the knowledge, skills, and attitudes needed to enact EBP.
r Active learning experiences can facilitate a progressive understanding of the statistical concepts essential for statistical literacy.
r Analogies that connect active learning exercises with clinical scenarios can help students understand statistical concepts and how evidence can influence care and outcomes.
Author information Amy Hagedorn Wonder, Indiana University, Nursing, Community and Health Systems, Bloomington, IN, USA; Julie L. Otte, Indiana University, Science of Nursing Care, Indianapolis, IN, USA. Address correspondence to Dr. Amy Hagedorn Wonder, Indiana University, Nursing, Community and Health Systems, 1033 E. Third Street, Sycamore Hall #408, Bloomington, IN 47405; [email protected] Accepted 5 September 2014 C 2015, Sigma Theta Tau International Copyright
References
To evaluate student understanding of the statistical concepts and the associated application to practice, faculty can challenge individuals and groups to develop other scenarios or to locate research reports that appropriately use the t- test to analyze other quality problems (e.g., patient falls, pressure ulcers). Student and group presentations provide a variety of practice examples while allowing faculty to gauge understanding. Homework and quizzes clearly aligned with the active learning objectives based on statistical output or published results are additional ways to gauge students’ understanding (Hayat, 2014).
Baker, A. (2014). Teaching quality control with chocolate chip cookies. Teaching Statistics, 36(1), 2–6.
RESULTS
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410-417.
Systematic evaluation of the effects of the learning experience is important. Initial feedback for the scenario used above was submitted by over 50% of the class at the end of the semester. The online survey provided quantitative and qualitative feedback with results suggesting that the active learning exercises and assignments had a positive impact on students’ academic and clinical development. Students reported that by beginning with simple exercises that allowed them to visualize and physically touch data, it enabled them to progress to more Worldviews on Evidence-Based Nursing, 2015; 12:2, 126–127. C 2015 Sigma Theta Tau International
Hayat, M. J. (2014). Guidelines for assessment and instruction in statistics education (GAISE): Extending GAISE into nursing education. Journal of Nursing Education, 53(4), 192– 198. Hayat, M. J., Eckardt, P., Higgins, M., Kim, M., & Schmiege, S. J. (2013). Teaching statistics to nursing students: An expert panel consensus. Journal of Nursing Education, 52(6), 330–334. Lee, K. H. L. (2007). Chocolate chip cookies as a teaching aid. The American Statistician, 61(4), 1–5.
Toole, B. M., Stichler, J. F., Ecoff, L., & Kath, L. (2013). Promoting nurses’ knowledge in evidence-based practice: Do educational methods matter? Journal for Nurses in Professional Development, 29(4), 173–181. doi 10.1111/wvn.12075 WVN 2015;12:126–127
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