Teaching and Learning in Nursing 14 (2019) 94–96

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Teaching and Learning in Nursing

journal homepage: www.jtln.org

Nurse educators' use of lecture and active learning

Tim Bristol, PhD, RN, CNE, ANEF, FAADN, FAAN a, Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN b,
Jacquelyn McMillian-Bohler, PhD, CNM, CNE c, Rita Wermers, MSN, ANP-BC d,
Daniel Hatch, PhD e, Marilyn H. Oermann, PhD, RN, ANEF, FAAN c,⁎
a
Walden University, Minneapolis, MN, USA
b
College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
c
Duke University School of Nursing, Durham, NC, USA
d
Arizona State University, Phoenix, AZ, USA
e
Duke University School of Nursing, Durham, NC 27710, USA

a r t i c l e i n f o a b s t r a c t

Article history: The results of numerous studies suggest that by using active learning strategies educators can improve student
Accepted 10 December 2018 learning outcomes. We asked 536 nurse educators teaching in prelicensure programs to estimate the extent
that they integrate active learning strategies into their courses. There were no relationships identified between
Keywords: the estimated extent of active learning use and program National Council Licensure Examination pass rates.
Active learning
© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Lecture
Nursing course
Teaching strategies

Introduction Bonwell and Eison (1991) popularized the concept of active learning.
Defined as learning activities that engage students, active learning
Educators have long defaulted to lecturing as a strategy for effi- encourages students to think deeply about what they are doing
ciently presenting course content. However, the teacher, in choosing (Hyun, Ediger, & Lee, 2017). Active learning is based on constructivist
to lecture, is assigning students to the relatively passive role of listen- theory, which emphasizes that, in order to learn, students need to be
ing. It is not surprising that many students are unable to apply infor- engaged with the content. With active learning, students are the pri-
mation from lecture in a meaningful way (Waldeck & Weimer, 2017). mary knowledge creators and focus (Cattaneo, 2017). In comparison,
There is a growing body of research highlighting how active learn- the traditional passive learning approach emphasizes the instructor,
ing strategies can promote deeper levels of information processing who, as the expert, lectures to students while they sit passively re-
than those achieved through listening to lectures. Despite the in- ceiving the information.
creased discussion of and evidence for active learning, it is not clear Active learning promotes higher-order critical thinking skills
how frequently nurse educators choose to use lectures or active and involves teaching strategies such as case studies, class debates,
learning strategies in their classes. The purpose of this article is to re- think–pair–share activities, role playing, peer teaching, gaming, the
port results of a survey regarding the extent to which nurse educators 1-minute paper, or questions embedded into a lecture (Adkins,
report they use lecture and active learning in their prelicensure 2018). When students feel included and capable, they are more
nursing courses. willing to work through challenging material. Active learning also
increases a sense of community among learners and instructors
Background (Umbach & Wawrzynski, 2005). Students who perceive a member-
ship in the classroom community feel valued and supported. They
are more likely to take ownership of their learning and consider
This research did not receive any specific grant from funding agencies in the public, new perspectives, a necessary step for learning to occur. Active learn-
commercial, or not-for-profit sectors. ing strategies provide this connection for students and also enable
⁎ Corresponding author. instructors to assess students' understanding of the course content
E-mail addresses: [email protected], (T. Bristol), [email protected],
(D. Hagler), [email protected], (J. McMillian-Bohler),
in real time. A systematic review of active learning in nursing and
[email protected], (R. Wermers), [email protected], (D. Hatch), health profession courses by Waltz, Jenkins, and Han (2014) showed
[email protected]. (M.H. Oermann). positive outcomes in 15 of 22 studies. Although many of the studies

https://doi.org/10.1016/j.teln.2018.12.003
1557-3087/© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
 T. Bristol et al. / Teaching and Learning in Nursing 14 (2019) 94–96 95

in the review represented low-level evidence, they provide a founda- Results

tion for further work.
Active learning increases students' retention of information, There were 536 respondents to the survey. Of these, 438 taught in
improves performance on course assessments, and increases prelicensure nursing programs and answered the three survey items.
standardized test scores (Styers, Van Zandt, & Hayden, 2018; Only a few faculty (n = 22, 5.02%) do not lecture in their courses or
Ulrich et al., 2017). Results from a study by Matsuda, Azaiza, use it less than 25% of the time (n = 66, 15.07%). Slightly more
and Salani (2017) support the concept that when students are (n = 84, 19.18%) use predominantly lecture (over 75% of classroom
connected with course content, learning outcomes improve over- time). Most faculty lecture to students anywhere from 26% to 75%
all. Active learning also improves students' perceptions of inclu- of the time (n = 266, 60.73%).
siveness in the classroom and their self-efficacy (Lumpkin, Nearly half of the respondents (n = 213, 48.63%) stated that their
Achen, & Dodd, 2015). A meta-analysis of science, technology, en- students would describe their classes as including equal parts lecture
gineering, and mathematics (STEM) courses demonstrated that and active learning or mostly lecture (n = 185, 42.24%). Few students
students in lecture courses were 1.5 times more likely to fail would describe classes in which only active learning strategies were
when compared with those in active learning courses. In addi- used (n = 24, 5.48%).
tion, average examination scores of the active learning course Pass rates in the majority of the respondents' programs, as re-
participants were 6% higher than lecture course participants ported by the respondents, were above the benchmark (n = 340,
(Freeman et al., 2014). 77.63%). Chi-square tests indicated there were no differences in
Active learning strategies may improve some student learning first-time NCLEX pass rates based on the percent of lecture used in
outcomes, but does using active learning strategies support new the classroom, χ 2(3, N = 438) = 0.45, p = .93, or the balance be-
graduate success on the nursing licensure examination? Most tween lecture and active learning in class, χ 2(3, N = 438) = 1.33,
literature regarding forecasting graduate success on the National p = .72.
Council Licensure Examination (NCLEX) is tied to traditional
markers including predictor examinations and course grades Discussion
(Hinderer, Dibartolo, & Walsh, 2014; Johnson, Sanderson, Wang,
& Parker, 2017). As a starting point, we conducted a survey to Active learning strategies engage students in the learning process
explore how educators perceive the extent of their use of lecture and encourage them to reflect on their learning. Although nursing
versus active learning in the classroom in prelicensure nursing students in many programs prefer to be passive learners, nursing fac-
programs. Although there is a large body of literature on active ulty are integrating active learning in their courses (Oermann, 2015).
learning strategies in nursing, the extent to which faculty across Often, active learning is implemented through collaborative group
schools of nursing perceive they use lecture versus active learning work, with students working together to analyze cases related to
in the classroom is not known. the concepts being learned in the class. A meta-analysis by Freeman
et al. (2014) of 225 studies comparing traditional lecture to active
learning in STEM disciplines demonstrated improved examination
Methods scores with active learning classes.
Teaching methods should be selected based on the learning out-
The study used a survey to collect data on the extent of time nurs- comes to be achieved and what methods would work best consider-
ing faculty lectured to their students in the classroom or engaged in ing those outcomes. Although many faculty have embraced active
active learning. The survey initially asked respondents if they learning, lecture is still an effective method for presenting informa-
taught in a prelicensure registered nurse or practical/vocational tion to students, particularly when the teacher integrates content
nursing program. Only those faculty who indicated they taught from multiple sources that students may not have access to or time
courses at the prelicensure level received the rest of the survey to read. Lecture allows the teacher to present up-to-date evidence,
items. which may not be available in textbooks, explain complex concepts,
The survey included three items. One item asked faculty to iden- and clarify confusing points for students. Through lecture, teachers
tify the percent of classroom time that they lecture to students, can highlight key points to remember and provide examples of how
with responses ranging from none to more than 75% of the time. A those concepts relate to patient care. Lecture also may be time saving,
second item asked faculty how students would describe their classes and it allows the teacher to provide information to a large number of
in terms of lecture versus active learning: possible responses ranged students at one time (Woodring & Hultquist, 2017).
from only active learning strategies (no lecture) in class to all lecture In developing and implementing nursing courses, multiple teach-
(and no active learning). One final item asked respondents to indi- ing methods should be used depending on the outcomes to be met
cate if their school's NCLEX pass rate in 2017 exceeded the national and student learning needs. In this study, we found widespread use
average. The survey items were reviewed by experts for clarity. No of active learning strategies in the nursing classroom but also a
demographic data or information about the nursing program was blend of these strategies with lecture. Few nursing faculty reported
collected. using solely active learning or lecture consistent with the goal of
An e-mail was sent to the NurseTim, Inc. list serve in August selecting the best methods for the outcomes to be achieved.
2018, with a link to the electronic survey. The survey remained Nurse educators want to know what teaching methods will best
open for 1 month, and there was no attempt to send reminders. support their students' learning. However, research on teaching
A respondent could only answer the survey one time. The study methods is often conducted in situations from which it is difficult to
was approved by the authors' university institutional review generalize. Teachers need to appraise the evidence regarding teach-
board. ing methods and make thoughtful choices for application with their
Responses were downloaded from the survey software to Excel own learners and courses. Monitoring and sharing the outcomes of
(Microsoft) and then to SAS Version 9.4 for analysis (SAS Institute using teaching practices in specific settings can be an important con-
Inc. Cary, NC). Data were analyzed with frequency statistics and bi- tribution to the scholarship of teaching and learning.
variate chi-square analysis to determine if there were differences in No differences were found in NCLEX pass rates based on the
NCLEX pass rates based on the extent of lecture and active learning faculty's perceptions of the extent of active learning in the classroom.
in classes. Many factors influence NCLEX pass rates, which were not examined
96 T. Bristol et al. / Teaching and Learning in Nursing 14 (2019) 94–96

in this survey. In a future study, demographic data should be collected the time. This survey found that, although faculty commonly use ac-
to verify pass rates and better understand characteristics of the school tive learning strategies in their classes, they blend these strategies
that could influence these rates. The extent of active learning versus with lecture.
lecture across the nursing program is not known but also should be
examined in a future study. Providing respondents with a definition References
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