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The Difference is Critical: Successful Educator Methodologies in Accelerated Nursing Programs from the Students’ Perspective


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Abstract:

This article explores the theories and teaching methods employed in a thriving 2nd degree accelerated nursing program (ANP) at Ursuline College (UC) in Pepper Pike, Ohio. This six-year-old program, which has achieved high NCLEX pass rates, emphasizes theoretically-based, student-centered, streamlined and stress-minimizing teaching techniques. Faculty recognize the critical nature of reciprocal, respectful student/teacher relationships, especially in a class of adult learners. Based on the experiences and concerns of one class of 2nd degree ANP students at UC, this article explores the similarities between the needs of these students and research findings about such learners elsewhere. First grounding the methods in theory, the article then details teaching techniques that succeeded with UC 2nd degree ANP students, such as expanded PowerPoint presentations, a mixture of classroom and online sessions, cinema features, case studies and demonstrations. Finally the article addresses solutions to stress in the accelerated classroom, using humor and a “behavior protocol” developed by one UC faculty. These findings add to the small body of research on procedures particularly suited to accelerated education.

Introduction

This article explores educational theories and methods used in a thriving 2nd degree accelerated nursing program (ANP) at the Breen School of Nursing of Ursuline College (UC) in Pepper Pike, Ohio. The six-year-old program has achieved and an NCLEX pass rates of a 95% overall average. The article evolved from the concerns of a class of 2nd degree ANP students whose first six courses featured the educational processes described below. In the group’s next courses, however, faculty used traditional teaching methods. The students found the first six classes so positive and the switch back to a more typical teaching style so difficult that they wanted to share their experience. These students performed much better in the class that had been adjusted to meet their particular needs than in the ones taught with methods used in the customary 8-week format.


J. Walker et. al.1 report finding little research on specific or preferred teaching methods for 2nd degree ANP programs. The study notes distinct, efficient, academically-sound educational processes that suit the values and presumed expectations of 2nd degree ANP students. The study profiles these adult learners as self-directed, mature, and highly motivated. The researchers note that 2nd ANP students expect a lot of the educational process, prefer distinct teaching methods, and especially desire supportive student/faculty relationships. The students in the Walker study demonstrate a pragmatic learning style, needing to know why certain material was required and trusting that instructors would teach the pertinent information. 1

These findings coincide with UC’s experience with 2nd degree ANP learners, who differ from traditional students in many ways. The 2nd degree ANP Ursuline students range from 23-50 years old. They are changing vocational direction and attending class while often also managing a home, caring for children, and/or performing a job. These learners at UC are high achievers who are paying for a second chance at a career. They express a strong need to succeed in the face of difficult circumstances. The students commute to Ursuline and spend long hours in class: 6-7 hours per class day vs. 1-2 hours for traditional nursing students. With a compressed schedule of 4 weeks per course rather than the typical 8, 2nd degree ANP learners at UC have little time outside of class to learn the material and complete the work. Due to the program’s unique nature and the particular needs of this cohort, faculty must constantly evaluate which teaching methods work and which need to be modified. This article emphasizes the need for refashioned teaching techniques and describes in detail a few that one class of 2nd degree ANP students selected as especially beneficial.

Theoretical Perspectives

UC’s eclectic teaching philosophy is founded in various psychological and nursing theorist perspectives, including those of Carl Rogers, Albert Bandura and Hildegard Peplau. The ideals of these experts and others embody the means in which the successful nurse educator can relate to 2nd degree ANP students.

Rogerian Philosophy

Carl Rogers’ person-centered approach2 encourages teachers to emphasize genuineness, honesty, empathy, and unconditional positive regard when relating to students. Rogers expresses the critical nature of such educational concepts as creativity, student-centered learning, critical thinking, and positive self-concept, among others. Following Rogers’ example, the nurse educator must accept students’ level of development and genuinely understand their needs.

Bandura’s Perspective

Albert Bandura’s Self-regulated Learning Model3 involves behavioral, environmental, personal and cognitive components. Bandura proposes that people learn vicariously through others. UC instructors utilize this perspective by teaching via example, with the instructors actually doing a demonstration before the students are expected to perform, particularly when students are inexperienced. Nurse educators model their personal character and the ways that they would conduct themselves in various hypothetical situations. They anticipate circumstances in which students can learn through observation. The end result is that these students learn to be competent nurses as well as professional and courteous team members.

Hildegard Peplau

Hildegard Peplau’s Seven Nursing Roles4 encourages a cooperative classroom atmosphere, with faculty helping to synthesize the learning experience for students, providing guidance, advocating for students, and applying clinical and classroom skills. The nurse educator must sustain such a mutually supportive classroom environment.

Methodology of the Ursuline College 2nd degree ANP

Lectures and PowerPoint Presentations
The Walker et. al. study1 found that 2nd degree ANP students have certain classroom needs and expectations. They often prefer reading the material before listening to the lecture. To accommodate this need, at UC all 2nd degree ANP lectures, study guides, assignments and syllabi are uploaded onto the college web-based system prior to the beginning of each course.

These nursing students sit in class for long periods of time. If they have to constantly take notes on lectures, they often overlook key facts or lose focus. The students prefer detailed PowerPoints to accompany faculty lectures.5 In-depth PowerPoints rather than the usual bulleted phrases (Fig. 1) help our students pay closer attention. With printed copies of the screens in front of them, 2nd degree ANP students can highlight important points rather than take copious notes. The practice focuses the content, helps alleviate some classroom stress, saves time and frees students to engage in classroom discussion. Faculty narrate the PowerPoints and enrich the dialogue with case studies, stories and real-life experiences, 5 providing material in both visual and auditory forms.


Hybrid Online and Classroom Learning
The 2nd degree ANP students studied by Walker et. al.1 expressed a greater preference than did traditional students for web-based or web-enhanced programs, especially ones that incorporate classroom interaction with instructors. The ANP learners at UC also appreciate the chance to work online outside of the classroom, and faculty find that the quality of student work is the same on the online days as when they are physically present in class. Hence the UC ANP blends classroom experience with online work completed off-site.

Each student signs a pledge promising to complete all of the required online study. On the first day of the course, students come to campus for class, to provide face-to-face engagement with faculty. On the second day, they continue their assignments but work online at their own pace in a location of their choosing. They use modules in a PowerPoint format with audio narration and complete online study guides as they watch and listen. Online information includes specific syllabus bullet “talking points”, to outline classroom and clinical information and directions for special projects. The instructor answers student questions during the week, using UC’s web-based system. Students return to campus the following week for exam and continued face to face instruction. These learners at UC express gratitude for the chance to work online. It also helps reduce the sensory overload that can occur after 7 hours in the cohort classroom.

Study Guides
The study guides prepared by the instructor and used online by students parallel the relevant course modules. The guides assist the 2nd degree ANP learners in focusing on critical information—the need-to-know versus nice-to-know. The scholastic philosopher William of Ocham6 professed that “entities must not be multiplied beyond necessity,” saying, “it is pointless to do with more what can be done with fewer.” The resulting principle, “Occam’s razor,” essentially sums up the expectations of the adult learner. These 2nd degree ANP students prefer to keep learning simple and bare-bones but relevant. The UC study guides also utilize the Vygotskian perspective7 or the zone of proximal development. Put forth by Lev Vygotskian, the principle involves leading learners in a problem solving process, using hints, questions and materials. The key to the successful use of this practice is to remember, leading does not mean telling.

Case Studies, Movies and Demonstrations
Walker et. al. found that 2nd degree ANP students prefer case studies to written description. UC’s ANP faculty members often integrate case studies into their courses. Instructors find that real-world examples help adult learners remember information and improve their critical thinking skills.5 Like Walker’s students, 2nd degree ANP students at UC like direct, evidence-based learning over what they view as extra information.

Similarly, students in the Walker study1 preferred actual demonstrations of skills to lectures about those skills. UC’s ANP students also appreciate interactive and role play experiences in class. Role play enactments include: mock job interviews, setting priorities and delegating in a clinical setting and interacting with patients and their families to mention a few.

Feature length movies and TV movies that are used as learning tools are based on actual health related issues and mental health issues. Class discussion follows concerning the content and ANP students answer questions prepared by the instructor related to the perceived theme.

 

Student-teacher Relationships
Since adult learners are older and more mature than traditional students, they expect instructors to treat them with a collegial level of respect.5 This was true in Walker’s study1 as well as at UC and elsewhere. Adult students feel that they have a lot to offer in terms of life experiences. Many chose to forgo previous careers in order to become nurses.5 These learners depend on faculty to be available to answer questions outside of the classroom in a timely manner. When not in class, UC faculty and students keep in touch via the college’s web-based course management communication system, office hours, e-mail and telephone.

Stress Reactions
Stress is a natural part of any college program but is magnified in the fast-paced 2nd degree ANP. The students at UC tend not only to see themselves as consumers with an enormous pressure to succeed, but they also experience stress and anxiety10 due to the relentless pace. ANP students also experience troublesome situations that persist over time, for instance trying to do too much at once, financial issues, problems in marital relationships, and child care.

In accordance with Weitzel and McCahon,9 UC faculty believe that less stressed students can learn more easily in class and perform better in the clinical setting. Educators must address this issue in 2nd degree ANP classes or any other intense learning environment.9

Stress can promote uncivil classroom behavior among adults as well as younger students. With many outside pressures added to the burdens of coursework, older students often work in crisis mode. Continual worry and anxiety can elicit and prime the same sympathetic physiological fight-or-flight arousal response as an emergency situation.11 Heightened arousal elicits the stress response that includes emotional and psychological changes accompanying behavioral changes, and bodily responses characterized by sympathetic and pituitary–adrenal cortical arousal.

Health changes or performance deficits may accrue if responses are unusually intense or prolonged.12

Carrying such extra stress for a long period of time can erode coping skills and lead to unacceptable behavior. UC faculty observed, at one point, students arguing in the classroom that was disruptive, unbecoming and unacceptable. Such impolite acts produce unnecessary tension and interfere with the educational process. To deal with this problem, one 2nd degree ANP instructor at UC developed and initiated a “behavior protocol.”

Behavioral Protocol (BP)
The Behavioral Protocol (Fig. 2) is a written document that takes into account the stress factor and explains the provocative behaviors that are undesirable in any educational setting. At the beginning of each 2nd degree ANP course, the instructor explains the rationale behind the protocol and gives 10 behavior points automatically to each student as positive reinforcement. Each student signs a pledge to uphold the BP as a reminder to be vigilant and take responsibility for their own actions. Unconstructive behavior results in response cost or points deducted from the perpetrator’s total at the discretion of the instructor.

The BP document gives the educators a basis for constructive action in case anything untoward should occur. Ursuline 2nd degree ANP faculty find that the BP also effectively motivates students, especially those who are conscious of extra dividends much like those of us who enjoy commercial rewards from our shopping purchase’s (e.g., gas station, grocery store, pharmacy etc.). The points motivate the students to maintain homeostasis without the potential for grade inflation. The BP emphasizes the value of civil conduct, clarifies faculty expectations and results in less classroom strife.


Humor
Another method of dealing with the intense 2nd degree ANP atmosphere is humor. Laughter elicits the release of endorphins, the body’s natural pain killers, and helps produce a general sense of well-being.13 Studies show that laughing lowers blood pressure, reduces stress hormones, strengthens cardiovascular functions, improves circulation, increases muscle flexion, oxygenates and boosts the respiratory system, and increases immune function which produce disease –destroying antibodies.14 Norman Cousins calls laughter “internal jogging”. He wrote “Anatomy of an Illness” and immersed himself in only funny movies and television shows and laughed himself back to health. 15

Given these insights, UC faculty offer humor in the 2nd degree ANP to break up the serious environment. They insert funny video and cartoon clips at random into presentations and provide comedy web sites.16 Students express appreciation for this comic relief.

Conclusion

This article addresses teaching methods and theoretical perspectives that have contributed to the success of the UC 2nd degree ANP graduates. It presents a comparison between our students’ needs and those of the learners studied by J. Walker et.al.1, supporting the effectiveness of UC’s diverse teaching methodologies. The behavioral protocol has proven to help combat unacceptable behaviors caused in part by stress. Ursuline professors consider the BP to be a valuable addition to the 2nd degree ANP and strongly recommend its use with any adult learners in similar situations. Faculty in UC’s 2nd degree ANP also use humor to reduce tension and provide a break in the long class day.
Further research needs to be completed regarding the most beneficial teaching methods for 2nd degree ANP learners. Faculty have recently encouraged students to apply key nursing concepts using new technology, including: digital storyboarding, prezi.com, Google documents, podcasts, wikis, U-tube, eye jot, video e-mail and web quest.17 Through further inquiry and sharing of successful methods faculty will be better prepared to meet the unique needs of this population.

Acknowledgment

The authors thank Dr. Beverly Schaefer, who provided technical insight.


References
1. Walker, J., Martin, T., Haynie, L., et. al. Preferences for teaching methods in a baccalaureate nursing program: How second-degree and traditional students differ. Nursing Education Perspectives. 2007;28(5):246-250.

2. Freiberg, H. Carl Rogers’ philosophy and current educational research findings. Person-centered review. 1988;3(1):30-40.

3. Bandura, A. Perceived self-efficacy in cognitive development and functioning. Educ.Psychol. 1993;28:117-148.

4. Peplau, H. Peplau’s theory of interpersonal relations. Nursing Science Quarterly. 1997;10(4):162-167.

5. Rico, J., Beal, J., Davies, T. Promising practices for faculty in accelerated nursing programs. J Nurs Educ. 2010;49(3):150-155.

6. Thorburn, W. The myth of Occam’s razor. Mind. 1918;27(3):345-353.

7. Sanders, D., Welk, D. Strategies to scaffold student learning: Applying Vygotsky’s zone of proximal development. Nurse Educ. 2005;30(5):203-207.

8. Parker, F., Faulk, D. Lights, camera, action. Nurse Educ. 2004;29(4):144-146.

9. Weitzel, M., McCahon, C. Stressors and supports for baccalaureate nursing students completing an accelerated program. J Prof Nurs. 2008;24(2):85-89.

10. Kohn, P.S., Truglio-Londrigan, M. Second-career baccalaureate nursing students: A lived experience. J Prof Nurs. Educ. 2007;46:391-399.

11. Sapolsky, R.M. Why Zebras Don’t Get Ulcers. A Guide to Stress, Stress Related Disease, and Coping. 3rd ed. New York, NY: W.H.Freeman Co; 1995.

12. http://www.acnp.org/g4/GN401000127/CH125.html

13. American Physiological Society. Anticipating a laugh reduces our stress hormones,
study shows. Science Daily. Available at http://www.sciencedaily.com. Accessed April
10, 2008.

14. Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J. Modulation of Neuroimmune
Parameters During the Eustress of Humor-Associated Mirthful Laughter. Alternative
Therapies in Health and Medicine, March 2001.

15. http://thehealingpoweroflaughter.blogspot.com/2007/07/how-marx-brothers-brought-
norman.html

16. http://www.timegoesby.net/weblog/2007/12/elder-comedian.html

17. Sharpnack, P., Baker, J. Wikis, blogs, you tube, and podcasts: How technology can
transform your classroom. Seminar presented at: Ursuline College Breen School of
Nursing Meeting; April 2010; Pepper Pike, Ohio.

Figure 1. Conventional vs. Embellished Power Point
 
Conventional PowerPoint   Sexual Harassment
--Definition of Sexual Harassment
--You do not need to accept the behavior
--You are permitted to say no
--You do not have to feel compelled to explain yourself
--You have the permission to report the incident

Embellished PowerPoint   Sexual Harassment
--Definition of Sexual Harassment: objectionable unwanted advances from one individual to another
--You have right as an individual and you can refuse to accept the behavior even from a superior
--You have the right to say no by putting your hand up and say “stop”, or say “let me out of here”
--If you feel compelled to explain yourself, you are making it easier for the perpetrator
--Your rights are being violated therefore, you can excuse yourself and leave
--Report immediately to your supervisor and document everything that was said and done
--Non-reporting allows this behavior to continue

 

 

 

Figure 2. Behavior Protocol (BP)

  • Respect is essential for the rights of others seeking to learn, respect for the instructor and the general goals of academic freedom. The expectations during the entire program, either in the classroom or in the clinical setting should meet the values and mission of our school
  • Successful learning experience requires mutual respect on the part of the student and the instructor. Neither instructor nor student should be subject to the other’s behavior that is rude, disruptive, intimidating, or demeaning
  • Student conduct which disrupts the learning process shall not be tolerated. There is a “zero tolerance” to all inappropriate insubordinate conditions and behaviors
  • There are 10 points per course given for good behavior immediately. If any of the behaviors below are noted during the course, points will be deducted from your 10 points
  • The number of points deducted will be at the discretion of the instructor without question
  • All students will sign a pledge to maintain the protocol
Behavioral Guidelines
  • Differences of viewpoint or concerns should be expressed in a manner which students and faculty may learn to reason with clarity and compassion
  • Civil and respectful attitude toward one another
  • Acceptance of the program, and to be resistant to gossip and stressful rumination from other students
  • Refrain from carryover of disgruntled attitudes from classrooms into the clinical setting or to outside agencies
  • Verbal and body language (e.g., eye rolling, sitting slumped in seats with hat covering eyes, spacing out during lectures, posturing in an immature manner, texting, working on other subjects etc.)
  • Verbal or physical threats, hand gestures, groaning and sighing loudly meant to intimidate other students and or instructors are unacceptable

    • This is considered a form of horizontal violence!
    • Students will take part in discussions willingly, and refrain from the temptation of monopolizing discussions
    • Students will attend all classes and must call for an excused absence
    • Avoid side conversations that interrupt the class and instructor (e.g., nudging one another, smirking etc.)
    • Refrain from in-fighting or arguing in the classroom
    • Avoid undermining the instructor’s authority and the ability to teach (e.g., anger about grading, questioning authority etc.)
    • Remember stress can be a culprit, but we are ultimately responsible for our own behavior therefore, if coping skills are not adequate you may find yourself behaving in a manner you would find distasteful and embarrassing after the fact
    • If you have specific issues, we have an open door policy to discuss these in an adult professional manner. You are not alone and you will have the appropriate venue (e.g., classroom meetings, office hours and remedial education) to work on problems if they exist
    • Instructors will do everything possible to set a civil climate

     

    Viola/2007/2008/2009/2010 revisions

    Janet Viola, Psy.D, RN

    Rose Beeson, PhD, RN

    Jimmy E. Wilkinson Meyer, Ph.D.

    Christine Richards, BA, SN., Michelle Frohwerk, BA, SN., Brenda Cardwell, BA, SN., Christine Carlozzi, MA., SN., Kathryn Cox BSB, SN., Ashley Fausnaugh, BS, SN., Walter Illingworth, BA. SN., Celine cNamara, BS, SN., Lisa Piechowski, BA., S.N., Anne Shure, BA, SN., Joseph Wise, BS., SN

    Corresponding Author: Dr. Viola, Ursuline College, Pepper Pike, Ohio 44124 (jviola@ursuline.edu).

    Author’s Affiliations:
    Assistant Professor (Dr. Viola), Coordinator and Faculty 2nd Degree Accelerated Nursing Program (ANP), Ursuline College;

    Assistant Professor (Dr. Beeson), Adjunct Faculty 2nd Degree Accelerated Nursing Program (ANP), Ursuline College.

    Adjunct Instructor, (Dr. Meyer), Ph.D., Independent Scholar, UCAP Accelerated Program, Ursuline College.

    Author’s Affiliations: The following are 2nd Degree ANP Senior Student Nurses (SN), Ursuline College

    Christine Richards, BA, SN

    Michelle Frohwerk, BA, SN

    Brenda Cardwell, BA, SN

    Christine Carlozzi, MA, SN

    Kathryn Cox BSB, SN

    Ashley Fausnaugh, BS, SN

    Walter Illingworth, BA. SN

    Celine McNamara, BS, SN

    Lisa Piechowski, BA., S.N.

    Anne Shure, BA, SN

    Joseph Wise, BS., SN

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