Strategies to promote critical thinking and active learning

Connie J. Rowles, DSN, RN

Nursing faculty spend a considerable amount of their time planning experiences to facilitate student learning. The selection of teaching strategies and learning experiences traditionally has been governed by behavioral objectives. However, nursing education has been undergoing a major revolution, with attention focused on how to teach students to think critically. Therefore nurse educators are continually reexamining the “best” way to teach and to empower students for learning. The purpose of this chapter is to identify strategies that students and faculty can use to promote learning. The chapter begins with a discussion of critical thinking as the basis for any teaching strategy. Developing effective learning experiences comes next. A variety of teaching strategies are then presented with a discussion of their use, advantages, disadvantages, and tips for making the learning experience interactive and meaningful.

Critical thinking and active learning

Thinking, reflective thinking, and critical thinking have been topics of discussion among educators for many years (Bandman & Bandman, 1995; Brookfield, 1987, 1995; Dewey, 1933; Facione, 1990; Halpern et al., 1994; Hunkins, 1985; Kurfiss, 1988; McPeck, 1981; Norris & Ennis, 1989; Paul, 1995; Perry, 1970; Siegel, 1980; Watson & Glaser, 1984). A recent search in the Cumulative Index to Nursing and Allied Health (CINAHL) located 58 articles about critical thinking even when the search was limited to full-length articles in English in the time frame of July 2009 through July 2010. One excellent source from the search is Romeo (2010). She reviewed the critical thinking literature and found issues related to the definition of critical thinking as well as issues in the use of instruments to measure critical thinking. She also cited the lack of findings that show a clear-cut correlation with factors that interest nurse educators, such as licensing exam pass rates and changes in critical thinking over time in the program. So, while there is still a lot in the literature about critical thinking, there are some who recommend a change in the dialogue about thinking in nursing. A brief discussion of some of the newer terms found in the literature follows. A common thread with the newer ideas is that they all build on a foundation of critical thinking.

Clinical reasoning

Clinical reasoning is the ability of the nurse to use critical thinking skills in the ever-changing clinical environment. It should include the “. . . context and concerns of the patient and family” (Benner, Sutphen, Leonard, & Day, 2010, p. 85). Clinical imagination and reflection are also part of clinical reasoning (Benner et al., 2010). The thought is that critical thinking is more a snapshot in time while clinical reasoning can accommodate the changing nature in clinical settings.

Clinical judgment

Clinical judgment can be defined as “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response” (Tanner, 2006, p. 204). Tanner acknowledges that problem solving, critical thinking, decision making, and clinical judgment are often used in the literature to mean the same thing.

Metacognition

Metacognition is the “self-communication process in which a person engages before, during and after performing a task” (Beitz, 1996, p. 23) and more commonly thought of as thinking about thinking. It is an active process of monitoring your own thinking. Kuiper and Pesut (2004) contend that it is the combination of metacognition (reflective thinking) and critical thinking that better describes the thinking necessary in nursing.

Clinical reasoning, clinical judgment, and metacognition are all important in nursing. However, the basis of all of these is critical thinking. This chapter focuses on critical thinking, the ideal critical thinker, and the related cognitive skills.

The ideal critical thinker defined

Most experts agree that if an individual is a critical thinker, he or she not only has well-developed critical thinking skills but also exhibits what are variously described as the disposition, attitude, or traits of a critical thinker (Baron & Sternberg, 1986; Facione, Facione, & Sanchez, 1994; Ford & Profetto-McGrath, 1994; Kataoka-Yahiro & Saylor, 1994; Paul, 1995; Pless & Clayton, 1993; Turner, 2005; Watson & Glaser, 1984).

This chapter uses Facione’s (1990) definition of an ideal critical thinker. This description was derived by a consensus of experts in critical thinking who participated in a Delphi study. The panel of experts included “46 scholars, educators and leading figures in critical thinking theory and critical thinking assessment research” (p. 34). The experts essentially agreed that

The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit. (p. 3)

Facione et al. (1994) suggest that the Delphi study description of an ideal critical thinker describes a nurse with ideal clinical judgment.

Cognitive skills (subskills) of critical thinking were also delineated in Facione’s (1990) Delphi study. These include the cognitive skills and subskills of analysis (examining ideas, identifying arguments, analyzing arguments), evaluation (assessing claims, assessing arguments), inference (querying evidence, conjecturing alternatives, drawing conclusions), interpretation (categorizing, decoding significance, clarifying meaning), explanation (stating results, justifying procedures, presenting arguments), and self-regulation (self-examination and self-correction) (Facione, 1990).

Critical thinking in nursing and nursing education

Nurses need a high level of critical thinking skills and a critical thinking disposition because nurses encounter multiple patients with the same health care needs. However, each patient responds to those needs differently. Therefore nurses are required to use their holistic nursing knowledge base to think through each situation to provide individualized, effective (evidence-based) care rather than simply to follow routine procedures.

Jones and Brown (1993) believe that nursing is practiced in complex environments with humans, who are complex beings. Technological advances and a knowledge explosion have also changed the face of health care. Thinking skills of the nurse become more important than the ability to perform the associated psychomotor skills. Case (1994) discussed the changing arenas for decision making as being not only at the bedside but also in quality assurance processes, delegation activities, shared governance, and management and executive roles. As health care reform extends patient care from the predominantly structured inpatient arena to the more unstructured outpatient or community arenas, critical thinking skills and empowerment become even more important.

Carlson-Catalano (1992), in discussing empowering nurses, believed that traditional curricula encourage students to be obedient, dependent, and fearful in caring for patients. She suggests that nurses in professional practice should be empowered and that students need to be treated as valued members of the profession. She offers analytic nursing, change activities, collegiality, and sponsorship as strategies for empowering nurses. These strategies would be addressed if nursing faculty adopted the principles of critical thinking as the foundation for practice.

Students must develop higher-order thinking skills. Brigham (1993) contends that faculty need to assist students to recognize how systems respond to specific health problems. Students need to know what nursing measures will be needed when they read laboratory reports with abnormal results; they do not need to memorize normal laboratory values. Jones and Brown (1991) argue that nurse educators can no longer convey facts to nursing students. “There are far too many facts, but there are far too many facts that become erroneous over time” (Jones & Brown, 1991, p. 533). Miller (1992) concurs:

More emphasis should be given to the mental processes students engage in as they solve nursing problems and less given to simply identifying the correct answer. Focusing on making clinical inferences from given data, recognizing unstated assumptions, deductive reasoning, weighing of evidence and distinguishing between weak and strong arguments emphasizes the importance of the processes of thinking. (p. 1406)

Scheffer and Rubenfeld (2000) conducted a Delphi study to develop a consensus statement about critical thinking in nursing education. A panel of 55 experts from 9 countries determined that

Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice [possess] the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. (p. 357)

In summary, Jackson (1995) states, “Every patient deserves caregivers who think critically . . . . The ability to think critically can be empowering. Practitioners must commit to a struggle of balancing an explosion of objective and intuitive information in an explosive health care environment” (p. 187). Therefore nurse educators are challenged to help students develop necessary critical thinking skills as the students progress through the curriculum.

Roles of faculty and students in developing critical thinking skills

The development of students’ critical thinking skills and dispositions requires faculty to reconsider their philosophy of teaching. The faculty-dominated classroom is not conducive to development of critical thinking. It is the responsibility of faculty to think about the roles of the teacher and student, as well as to create an environment that empowers students. Transmitting information through rote lecture to students does not guarantee learning. Students must be actively engaged with the information for it to be transformed into knowledge. Lesson plans must be designed to foster the development of critical thinking skills (cognitive) and a critical thinking disposition (affective) as students engage with the theoretical, affective, and psychomotor content that is nursing. Students must become empathetic, empowered, and able to critically think about every situation if they are to succeed in nursing (Bevis, 1993; Ford & Profetto-McGrath, 1994).

Faculty roles

Faculty must become facilitators of learning rather than teachers of content (Bevis, 1993; Brigham, 1993; Brookfield, 1995; Creedy, Horsfall, & Hand, 1992; Jones & Brown, 1993). Ford and Profetto-McGrath (1994) believe that the teacher–student relationship must become a “working with” relationship—an egalitarian relationship. Burns and Egan (1994) suggest that faculty should demonstrate critical thinking as content is presented. For example, when teaching content such as medical acidosis and alkalosis, faculty could demonstrate their own problem-solving skills by thinking aloud as they discuss a relevant case study. Students should think aloud while interacting with the content so that faculty can identify inappropriate thinking processes and provide immediate constructive feedback.

Creedy et al. (1992) propose that faculty can empower students by valuing their contributions, encouraging expression of their opinions, exploring mistakes objectively without demeaning the students, and promoting risk taking. Brookfield (1987) cites the following principles that will facilitate students to think critically:

• Affirm the critical thinkers’ self-worth (p. 72).

• Listen attentively to critical thinkers (p. 73).

• Show that you support critical thinkers’ efforts (p. 74).

• Reflect and mirror critical thinkers’ ideas and actions (p. 75).

• Motivate people to think critically (p. 76).

• Regularly evaluate progress (p. 78).

• Help critical thinkers create networks (p. 79).

• Be critical teachers (p. 80).

• Model critical thinking (p. 85).

Thus according to Brookfield (1987), the facilitator of learning must enter into an egalitarian relationship to support the learners’ attempts to engage in critical thinking. Faculty can only provide learning experiences for students; faculty cannot teach (impart knowledge); they can only share their knowledge. Students must transform the content into their own knowledge.

Student roles

Learning to think critically requires active student participation (Meyers, 1986); students must become active creators of their own knowledge (Creedy et al., 1992). At this time, it can be assumed most students have come from faculty-dominated classrooms in which the students have been the recipients of endless amounts of facts to be memorized and recalled for examinations (Valiga, 1983). Students have probably not been asked to apply those facts to real-life situations. Therefore students will have to be assisted with the transition from the passive to active learner role. Faculty need to create a risk-free environment that is conducive to active student participation. The discussion later in this chapter related to creation of an anticipatory set serves as an example of helping students to make the transition from passive to active learners. Repeated encounters with active learning situations are needed before students can become comfortable with the active learner role.

Active learners must come to class prepared. They cannot rely on the faculty to tell them what they need to know. “Preclass written assignments, study guides, quizzes and short in-class writings” (Brigham, 1993, p. 52) are effective in stimulating students to come to class prepared to engage with the content while interacting with faculty and fellow students in planned learning activities.

Classroom environment for the development of critical thinking skills

The classroom environment changes when the principles of critical thinking are adopted. Active learning can be a very threatening situation. Faculty must create a risk-free environment that allows students to explore the content, make mistakes, reflect on the content, associate the content with experience, and transform the content into knowledge (McCabe, 1992).

Brigham (1993) suggests that faculty set the stage by sharing that their philosophy of teaching is to enhance critical thinking. This should be done when students are being introduced to the course. Students need to know that learning experiences have been designed for them to actively engage with the information and with each other while faculty facilitate the activities and learning process. Students must understand that, through the interactions, information will be converted into knowledge (Bevis, 1993).

Classroom environments should establish a sense of connection between faculty and students and among students themselves. Students should understand that neither faculty nor students have all of the answers and that no one answer is correct in all situations. Open discussion and student willingness to take risks should be supported while faculty guide the group toward the preestablished learning outcome.

Students need to be aware that there are conflicting ideas about some concepts. Faculty at some schools of nursing do not adopt a specific textbook for their courses; rather, the bookstore stocks appropriate textbooks by different authors and students select the textbook they would like to use. This particular idea is intriguing because it certainly provides a basis for discussion of information from multiple points of view. When contradictions are found, it helps students recognize that the written word should be questioned.

The physical component of the classroom is important; however, any classroom can be conducive to active student learning. Students should be able to make eye contact with each other and with faculty. MacIntosh (1995) suggests rearranging chairs into small or large circles. Faculty can be creative in modifying the physical characteristics of the classroom. For example, in classrooms where desks are bolted down, students could sit on the tops of the desks to be able to face others in the group.

Student responses to active learning

Beck (1995) conducted a study using a cooperative learning model based on feminist pedagogy that resulted in positive teacher–student and student–student interactions and satisfactory learning. Hezekiah (1993) cites the five basic feminist goals for the classroom—“atmosphere of mutual respect, trust and community, shared leadership, cooperative structure, integration of cognitive and affective learning, and action oriented field work” (pp. 55–56)—that would establish an environment for the development of critical thinking skills as the learner transforms information to knowledge. Wake, Coleman, and Kneeland (1992) discuss shared governance in the classroom. They note that shared governance in nursing education produces professional nurses who will be prepared to practice in an ever-changing health care environment.

Price (1991) found that “interaction between the student and teacher ranked high as a positive contributor to learning” (p. 170). Price cited the following student responses to the benefits of an interactive classroom:

What’s good is your understanding of conflicts we may be facing as new students, your continual encouragement, and the fact that you’re always available to answer questions . . . I don’t function well, never have, when the question is memorizing. . . . I tend to learn very abstractly and not sequentially; my learning is not textbook learning. . . . I really find that I learn the most when I can apply it to myself and to someone else; that’s the thing I can underline and say, “Yes, I learned that very well.” . . . It’s practical application, where it’s applied to life, where your pattern of behavior is changed, something you can apply in your relationship with another human being. (pp. 170–171)

Summary

Nurses must possess a high level of critical thinking skills and a critical thinking disposition. Faculty must create opportunities for students to develop critical thinking as they progress through the curriculum. Faculty must become facilitators of learning and students must become active learners.

Critical thinking should be at the forefront of planning learning experiences for nursing students. If educators believe that “students can and should think their way through the content of their courses, . . . gain some grasp of the logic of what they study, . . . develop explicit intellectual standards, then they can find many ways to move instruction in this direction” (Barnes, 1992, p. 22). Faculty must create an environment that develops the traits of an ideal critical thinker and plan learning experiences that include strategies to develop the cognitive skills and subskills of critical thinking.

Planning learning experiences

Planning challenging encounters that will entice students to learn and develop critical thinking skills is a major task for any faculty member. Effective planning of any kind requires much time and effort; planning learning experiences is no exception. Careful planning of each learning experience gives teachers more self-confidence and aids in formative and summative evaluation of teaching. At least six steps are used in designing learning experiences:

1. Determine the learning outcomes for the specific class period.

2. Create an anticipatory set.

3. Select teaching and learning strategies.

4. Consider implementation issues.

5. Design closure to the learning experience.

6. Design formative and summative evaluation strategies.

Each of the stages is discussed in detail. All steps can be planned by both students and faculty. Novice faculty may find it helpful to design learning experiences in great detail (Table 15-1), whereas more experienced faculty may use only a more general outline form.

Table 15-1

Sample Plan for a Learning Experience: Ethics in Leadership

1. Outcomes: Identify ethical theory used for own decision making. Discuss implications of use of ethical theories in the workplace.
Activity	Content	Time	Strategies
2. Anticipatory set a. Preclass assignment b. In-class exercise	a. Ethical theories b. Ethical case examples c. Ethical situations	a. 2 hr b. 10 min	a. Text reading b. Ethical survey c. Individual reflection to identify the most difficult question on the survey and write how and why answered
3. Implementation tools a. Projector b. PowerPoint slides	a. Three ethical theories from text b. Application (1) Identify own theory used. (2) Apply to familiar situation. (3) Apply to new situation. (4) Apply to workplace decision making.	a. 40 min b. 30 min	a. Large group discussion (1) Slides of the theories’ main points (2) At each main point ask, “What does this mean to you?” and “Give an example of how the point would be seen in practice.” b. Small group discussion (1) “Which theory do you use?” (2) “Give example of how you used the theory.” (3) “How would a nurse administrator use the theory to make ethical decisions?” (4) “How could use of the theories lead to conflict in the workplace?”
4. Closure	Emphasize class outcomes.	20 min	a. Small group reports b. Overall summary

Determining the learning outcomes

The first step is to determine the learning outcomes of the class. Several activities must be carried out before specific outcomes for any class period are developed. The first activity is assessment of the overall curriculum outcomes and the placement of the specific course in meeting these outcomes. Typically, general curriculum outcomes are stated in very broad terms and will likely not give the teacher any information about what to include in a specific class period. However, a thorough understanding of the broad curriculum goals is necessary so teachers can “connect” the specifics for the day to the broad curriculum outcomes. Course objectives and outcomes need to be reviewed to ascertain how the particular course “fits” within the curriculum (Ayer, 1986; Torres & Stanton, 1982). See Chapters 8 to 11 for additional information.

Teachers tend to design learning experiences within their own belief and value systems. Their own philosophies about teaching, learning, the curriculum, the ability of students, and how and what a nurse educator “should” do all influence the development of activities for a specific class period. Teachers need to be aware of these value systems and recognize the influence of them on their teaching and selection of teaching strategies (Creedy et al., 1992).

With these activities in mind, outcomes for a given experience can be established. There are several ways to identify outcomes. One way is to use behavioral objectives (see Chapters 9 and 10). For many, however, behavioral objectives imply rigid lists of specific content, faculty-dominated classrooms, and only one right answer to each examination question. Some believe that specific behavioral objectives need to be abandoned, given the important issue of development of critical thinking abilities in students (Bevis, 1993). In another approach, general outcomes or competencies are identified, and the path to achieving them is left open. How they are written depends on individual school requirements, the overall curriculum design, the content of the course, and the beliefs or values of the individual faculty member.

Creating an anticipatory set

The second major step in planning a learning experience is to create an environment that invites all students to become interested in the content and to participate in the learning process. This activity is referred to as creating an anticipatory set (Ayer, 1986; deTornyay & Thompson, 1982; Maas, 1990). The activity typically takes little in-class time and merely sets the stage for active involvement in the learning process. Maas (1990) includes three elements in an anticipatory set: active participation, relevance to the students, and relevance to the class period. Preclass readings; active, thought-provoking questions; and a class exercise that emphasizes students’ prior knowledge are examples of activities that can be used as an anticipatory set. The anticipatory set prepares students for the main activity or content of the class period.

Selecting a teaching strategy

Selecting the particular teaching strategy is the third step in lesson planning. Faculty must consider multiple factors as they select a particular strategy. The first factor is the content itself. For example, teaching abstract concepts is probably better accomplished through mind mapping (Rooda, 1994), whereas psychomotor skills are better taught through demonstration (Kelly, 1992). The philosophy underlying the broad curriculum outcomes also influences the selection of teaching strategies. In a school that has adopted the principles of critical thinking, the traditional lecture would seldom be used as a strategy. Last, faculty must consider teaching strategies that are feasible. Questions to consider may include the amount of time available, room size, distance learning delivery system being used, the availability of equipment, the number of students, time and money costs for both the teacher and the student, and learning styles of the students.

With these factors in mind, many different teaching strategies would be appropriate for any student group and class content. Throughout the course it is important to vary the strategies. Using the same type of anticipatory set followed by lecture and then the same closure can be very boring for students. For example, faculty may create interest for the students by using lecture some of the time and role play, demonstration, and reflection at other times.

Varying the strategies also has the advantage of appealing to all types of learners (see Chapter 2). Few of the teaching strategies are equally stimulating to all types of learners. It is not particularly important that teachers use strategies that appeal to all learners in every class, but it is important for them to use strategies that appeal to all types of learners throughout the course. Questioning is a teaching strategy that should be used consistently; it can even be used in every class (Paul, 1995). “Helping students to ask their own questions should perfect their ability to think critically about information and how to process it” (Hunkins, 1985, p. 296). Strategies that appeal to one type of learner can also be used for the preclass assignments or activities, and strategies for other types of learners can be used for the classroom experience.

Teaching strategies and critical thinking

The actual steps in designing learning experiences do not change when critical thinking concepts are applied to the curriculum. Teaching strategies should be selected for the development of critical thinking skills. Development of these skills in students should be a planned activity throughout all stages of the curriculum. Any strategy selected should be selected for a particular reason, and all strategies should lead to the development of advancing levels of critical thinking.

Cognitive levels

Cognitive levels must be considered during lesson planning. Several theorists have written about the various cognitive levels of students. Perry (1970) identifies four levels including nine stages of intellectual development. Belenky, Clinchy, Goldberger, and Tarule (1986) have demonstrated that women and men differ in intellectual development in several major areas. One example is that women typically have a silent stage of cognitive development, which is the first level. This stage is characterized by a powerless, dependent fear of authority figures. Men typically do not go through the silent stage.

Hickman (1993) examined the theories of Perry (1970), Belenky et al. (1986), and others and integrated their thinking on cognitive levels with Benner’s (1984) levels of skill acquisition. Hickman’s (1993) thoughts are related directly to the licensed nurse, but her ideas can also be applied to the undergraduate nursing student. The beginning nursing student is a novice in critical thinking. Thinking is characterized as dualistic (everything is black or white). Little or no critical thinking is used. The novice depends on authority for knowledge and is usually silent. The next cognitive level is the advanced beginner. In this stage, thinking at the multiplicity level occurs. Students use subjective knowledge to begin seeing recurring themes, but they fail to differentiate important cues. Students at this level require assistance in establishing priorities. The next stage is the competent student nurse. At this stage, students continue to use subjective knowledge, but they do so consciously and they use the subjective knowledge in deliberate planning activities. The last cognitive level is the proficient student nurse, who is at the relativistic level of intellectual development. Relativism is the recognition that opinions differ in quality and require supporting evidence to be valid. Relativism is equated with procedural knowledge, connected knowledge, or both. Students no longer see information as only black and white; they begin to see how things “fit” together and notice where information is missing. They begin to think critically.

It would be hoped that students completing a basic nursing education program would have attained the relativism level of cognitive development. Most undergraduate students will not have attained the final level, which is commitment in relativism. Commitment in relativism describes the expert nurse who integrates knowledge with experience and uses personal reflection to derive constructed knowledge (Hickman, 1993). Many graduate students will have already moved to this level. Undergraduate nursing students will likely move to the final level of cognitive development after they are licensed and have many more real-life nursing experiences and the time to reflect on and integrate those experiences.

The cognitive level of students must be addressed when learning experiences are designed. Moving students from the cognitive level of dualism to the level of relativism should be a major goal of nursing education. The level of cognitive development also influences the selection of teaching strategies. Bowers and McCarthy (1993) suggest that students who exhibit thinking at the informed commitment (relativistic) level would probably feel frustrated if they were expected to think at a dualistic level. For example, proficient student nurses would rather discuss implications of abnormal blood gas values (relativistic thinking) than respond to questions about normal findings (dualistic thinking).

Implementation issues

The fourth stage of lesson planning is implementation of the learning experience. In this stage, two major activities are considered. The first is the timing. How much time will be spent on the strategies selected to develop the anticipatory set? What backup plans are made to account for a lesson that takes much less or more time than anticipated? What can be cut or what can be added? What are the most crucial concepts to be covered if time is short? The sample plan (see Table 15-1) contains estimated times, with more detail included in a more extensive version of the plan.

The second activity in this stage is to plan for the tools needed to implement the class. In this case, tools can refer to many things. Tools can be instructional media and equipment such as a projector, computer, or video information system (see Table 15-1). Tools can also refer to the information technology tools used to establish the learning community, such as computer conferencing or video conferencing. Plan to check the equipment for correct working order. Nothing can ruin a well-planned learning experience quite as effectively as instructional media that do not work! Tools could also be the classroom itself. How should the chairs be arranged? Do you want to use a podium? Does the screen for the projector or computer work? The last set of tools is the paper products. What handouts does the faculty member need? How much lead time is needed for typing and copying the handouts? Are the computer slides or transparencies ready? Are there items that need to have copyrights cleared? Who does that and how much time does it take? Assessing and planning for the amount of time and the tools necessary for implementation of the teaching strategy are activities that should not be left to the last minute.

Designing closure

The last step in designing the learning experience is planning for closure. Closure may be as simple as a few sentences that summarize the major concepts. In this case, the time allowed for closure would be very short. However, closure can take a large amount of class time, especially when dealing with sensitive or emotional content. Applying major concepts to similar or new areas of interest is another example of a closure technique (deTornyay & Thompson, 1987). This time may also be used to create the anticipatory set for the next class period by discussing how the content of the class relates to the content of the next class period.

Designing formative and summative evaluation strategies

During the lesson planning phase, both formative and summative evaluation need to be considered (Ayer, 1986). Chapter 16 contains information about classroom assessment, and Chapters 24 to 26 contain information about assessment of learning outcomes. These chapters should assist in this stage of planning.

Evaluation activities should occur throughout the learning experience. Many formative evaluation techniques are available (see Chapter 16). Frequent formative evaluation is important for assessment of students’ understanding of content. Varying the types of formative evaluation used is important. For example, sometimes the objectives can be evaluated and at other times the teaching strategy used can be evaluated. Frequent self-evaluation is critical. Faculty should ask whether the time, tools, strategy, and content were organized and planned effectively and what could have been done differently to enhance student learning.

Summary

Designing effective learning experiences involves at least six distinct stages. A well-designed experience that enhances student learning cannot be done in a haphazard manner or at the last minute. Enhanced student learning and the development of critical thinking skills are the outcomes of well-planned learning experiences.

Teaching strategies

There are many different teaching strategies. Those with the most application to nursing education are presented throughout the rest of the chapter. Each strategy is described with its advantages and disadvantages, teaching tips, and additional references where the reader may find a more detailed description of the strategy.

Simulation is a teaching strategy that is growing in use in nursing education; it is discussed in detail in Chapter 20. Other teaching strategies may be more appropriate for the online learning environment. A detailed discussion can be found in Chapter 23. Any discussion about teaching strategies would be incomplete without a review of learning resources, including instructional media or distance education delivery systems. These are discussed in Chapters 19 to 23.

The lecture is presented first, because this teaching strategy is frequently used by many teachers. Many other strategies can be used in nursing education. These strategies are alphabetized for ease of location. Each strategy discussed may have its place in a course, but its use depends on the content, the teacher, and the learners.

Most of the strategies described after the lecture involve active learner participation in the learning process and emphasize adult learning and critical thinking concepts. Both teachers and students may resist this type of learning because the strategies are more flexible and less teacher centered than those typically used in the traditional college classroom. However, if one accepts that the learner must actively engage with the content or information to transform it into knowledge, the classroom should become student centered. Thus the traditional lecture may not always be the most appropriate strategy.