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A Capstone Teaching Project for Undergraduate Nursing Students: Development of a Visual Teaching-Learning Tool Carol Diane Epstein, PhD, RN, FCCM
Abstract
[Query #1: Please provide a brief abstract (about 150 words) for your article.]
T
his article describes an original capstone teaching project, which is aimed at fostering the goals of preparing senior nursing students for autonomous professional nursing practice, enhancing their ability to apply teaching-learning principles to patient education, and integrating the activities of health promotion, maintenance, and restoration with clients in a variety of health care settings. Students complete their capstone project during their final semester in a clinical practicum entitled, Transition: Professional Nursing Practice. A senior practicum provides nursing students with a unique opportunity to apply knowledge attained throughout the entire curriculum under the direct supervision of an experienced, baccalaureate-prepared clinician (Bryant & Williams, 2002). A supportive and structured preceptorship provides students with
Received: May 24, 2005 Accepted: November 11, 2005 Dr. Epstein is Associate Professor, Fairfield University School of Nursing, Fairfield, Connecticut. Address correspondence to Carol Diane Epstein, PhD, RN, FCCM, Associate Professor, Fairfield University School of Nursing, 1073 North Benson Road, Fairfield, CT 06824-5195; e-mail:
[email protected]. edu.
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an in-depth clinical experience and, at the same time, enables the unit manager and nursing staff to assess the students’ potential as new graduate employees (Mills, Jenkins, & Waltz, 2000). However, capstone courses that are not accompanied by a didactic component present special challenges to nursing faculty. Faculty need to think creatively about the kind of assignment that can meet the course objectives while remaining sensitive to the fieldwork quality of a course that occurs beyond the classroom. The concept and application of the capstone teaching project was designed by the author to address these multiple issues.
Background
In a report issued by the Agency for Healthcare Research and Quality, the development of evidence-based, patient education initiatives is a critical but often neglected priority of professional health care providers (Berkman et al., 2004). The existence of significant links between low health literacy and poor patient outcomes led Berkman et al. (2004) to recommend that health care providers move beyond the written form of materials whenever possible to work toward improved health literacy among patients receiving care. To this end, the capstone teaching project described in this article placed patient education at the forefront as the primary assignment for the senior practicum. The project is best conceptualized as a semester-long practicum during which students are immersed in the phases of the teaching-learning pro-
cess: l
Identification of the learning
need. Creation of the teaching tool. Development of a written paper describing the first two phases. l Two oral presentations. By the end of the semester, students develop three products: a threedimensional teaching tool called a Visual Project, a written paper describing the processes and outcomes of the project, and two oral presentations of the project to the nursing staff and to the School of Nursing faculty and students. During the Transition course, students are expected to provide theory-based care that incorporates nursing research findings and to perform patient and family teaching. Decision making, collaboration, autonomy, and evaluation are emphasized. l l
Visual Project
The Visual Project is an evidencebased, three-dimensional teaching tool created by the students and handed over to their clinical units at the end of the semester. This tool meets a teaching-learning need of the individual student’s patient, the patient’s family, or the nursing staff who provide care. It was reasoned that the option of including nursing staff learning needs would be beneficial to patient education and nursing care. The concepts of communication, collaboration, critical thinking, and therapeutic intervention are embedded in the capstone teaching project. Project Topic Identification
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There are several steps to creating the Visual Project teaching tool. The first priority is for students to identify a clinically significant teaching-learning need supported by the scientific literature. The scientific literature and, in particular, state of the science reviews help students identify significant learning needs. Students are encouraged to examine what is known and not known about the learning need, gaps in knowledge, and descriptions of previously tested teaching tools. Students may identify a tool that has been successfully used in one patient population and consider whether it could be adapted to a different one. Students are encouraged to discuss the topic with the preceptor and query other nursing staff. The faculty instructor engages the students, the preceptors, and the unit managers in focused discussions of potential topics. Ideas for learning needs are also identified during multidisciplinary rounds or when students accompany an advanced practice nurse on rounds. Several students said they were able to generate the seed of an idea simply by reflecting on the topic during patient care activities and observing everyday clinical nursing practice. For example, one student observed that a patient hospitalized in the intensive care unit and her family members did not seem to understand the terminology underlying end-oflife care, such as do not resuscitate, symptom management, and comfort care. This initial observation led to a series of discussions among clinical staff and administration personnel about the issue itself, as well as about potential visual teaching tools that could be created to address this learning need. Critical thinking was used by members of the multidisciplinary team to generate a working definition of the learning need itself. For example, did the patient’s family members really want to know what these terms meant, or were they seeking help and support in deciding whether to withdraw life support? The characteristics of appropriate literacy level, graphic quality, creative use of color, accessibility to re
visions, feasibility, and durability are important attributes of the teaching tool. In one case, two students created a well-designed, online critical care orientation curriculum for new nurse employees. The online program enabled clinical nurse specialists based in each intensive care unit to update the program as needed and to be notified of changes made by other educators in real time. The hospital administrators were so impressed with the project that they encouraged the students to consider seeking a patent for the program so it could be purchased by hospitals. It is important that students confirm the final project topic with their unit managers because the manager may have already “saved” a project for the student to carry out. For example, one student thought he had a useful idea for his project related to the avian influenza virus. However, when the student met with the unit manager, the manager gently redirected him to focus on the bedside clinician’s response to a terrorist incident. In addition to seeking approval from the unit manager, students must propose the final project topic and teaching tool to the faculty instructor and discuss the scientific rationale underlying the project. For example, the faculty instructor can help assess whether the scale of the project is too complex or whether feasibility issues are insufficiently addressed. Project Creation
Students often say that after they have identified the learning need and developed a concrete idea for the teaching tool, they are eager to move on to the second phase of the project, that is, creation of the Visual Project. Students are encouraged to create a teaching tool that is durable, easy to use, and accessible to revisions as the scientific literature warrants. Students document the accuracy of the written content, which is also verified by the faculty instructor. The written content is geared to no higher than a sixth-grade literacy level. For example, the student mentioned above who questioned whether the patient and her family members comprehended
the terminology associated with endof-life care created a graphically attractive brochure on this topic, which is now used in all of the hospital’s intensive care units. Prior to actual distribution, the brochure’s content was evaluated and approved by the hospital’s patient education committee. The student mentioned above who addressed the instructions for bedside nurses in response to a terrorist incident created a colorful algorithm that was laminated and placed in every patient care room. At times, students initiate and model leadership behaviors by advocating for the unit beyond the institutional structure. In one situation, the emergency department staff of a busy, urban teaching hospital assessed that parents may need to learn how to accurately measure their child’s body temperature at home. The student created a colorful brochure that included photographs depicting how to measure temperature and instructions for management of fever. In addition, the student contacted several companies until she located one willing to donate a large quantity of forehead thermometers to be distributed to parents of discharged pediatric patients. [Query #2: Is sentence OK as edited?] Many students demonstrate awareness of the effects of ethnic and socioeconomic issues (e.g., the presence of a language barrier, low literacy level, lack of adequate social support at home) on successful learning outcomes. In one case, the pediatric staff determined that the parents of some pediatric patients with special physical needs, such as cerebral palsy, needed to learn how to perform cardiopulmonary resuscitation at home. As part of a larger patient education program, the student located a videotape distributed by the American Heart Association and translated the content into Spanish. Another student translated the pediatric nursing assessment into Spanish and laminated it on fiberboard. Using a hole punch and a key ring, the assessment form was placed in every patient room. A poster format works best if it can be mounted on a wall, because posters Journal of Nursing Education
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placed on cabinets or bookcases are often damaged and eventually discarded. The teaching poster format was used by one student who developed keen sensitivity to the issue of caregiver burden among family members whose loved one is hospitalized in an oncology unit. The student observed that family members frequently stroll around the unit while allowing the patient to rest. The poster addressed the topic of caregiver burden, signs and symptoms, and management strategies. Several families remarked that the poster’s message resonated well and inquired further about available resources.
Written Assignment
The third phase of the capstone teaching project is an academic paper that describes the personal teachinglearning process each student experienced during the practicum. The learning need and the rationale for the kind of teaching tool developed are discussed in terms of the scientific literature. Grading criteria include points for a literature review, identification of a rationale for the teaching tool, accuracy of information, grammar, and overall quality of the project.
Oral Presentations
The final phase consists of dissemination of the capstone project via two oral presentations. Students present the Visual Project to the unit nursing staff and to the School of Nursing faculty and students. Anecdotally, students frequently comment on the personal effects of presenting their project to the nursing staff, knowing that the nurses will make use of the teaching tool in their nursing practice. Seniors are ready to graduate and, in many cases, will be working in the same unit where they completed their practicum. As a result, the quality of the project is important because the students know the nursing staff will associate them with their projects. The act of giving the teaching tool to the unit to be used in the future functions is a symbolic form of thanking May 2007, Vol. 46, No. 5
the host institution for providing the clinical experience to the students. In some hospitals, the education coordinators who facilitate the student placement view the presentations as a cause for celebration. At several institutions, oral presentations are conducted during a luncheon. Students prepare for this kind of event by creating a PowerPoint® presentation to accompany their oral presentation. Students also present their projects to the faculty and students at the School of Nursing. Students display their projects in a large room equipped with ample table space and refreshments. Attendees and participants have the opportunity to ask questions and exchange ideas. Students present their projects in a relaxed manner because of the festive atmosphere. Students consistently express a sense of accomplishment when they present their projects and recognize that they themselves have undergone the same teaching-learning process that was the focus of their project.
Evaluation
Students complete a qualitative evaluation form related to this assignment; 100% of the 58 seniors described the capstone teaching project as a positive and interesting experience. Nurse educators commonly hear students complain that patient education is boring; in this regard, the qualitative findings are encouraging. To evaluate the effectiveness of this project as an educational intervention, testing through appropriate research methods would be useful. Certainly, evidence-based nursing education refers not only to the substantive content presented to students; the methods of presenting that content deserve much greater scrutiny and further testing (Yonge et al., 2005).
their skills in communication, collaboration, and critical thinking to the teaching-learning process. Because the students are directly responsible for creating a teaching tool, patient education becomes, for many, “alive” and important. This capstone teaching project involves senior students in a concrete, research-based patient education experience prior to starting their first clinical position, when they will be accountable for this kind of professional activity.
References
Becker, M.K., & Neuwirth, J.M. (2002). Teaching strategy to maximize clinical experience with beginning nursing students. Journal of Nursing Education, 41, 89-91. Berkman, N.D., DeWalt, D.A., Pignone, M.P., Sheridan, S.L., Lohr, K.N., Lux, L., et al. (2004). Literacy and health outcomes. Evidence Report/Technology Assessment No. 87 (AHRQ Publication No. 04-E007-2). Rockville, MD: Agency for Healthcare Research and Quality. Bryant, S.C., & Williams, D. (2002). The senior practicum. Nurse Educator, 27, 174-177. Mills, M.E., Jenkins, L.S., & Waltz, C.F. (2000). Emphasis courses: Preparing baccalaureate students for transition to the workforce. Journal of Professional Nursing, 16, 300-306. Yonge, O.J., Anderson, M., ProfettoMcGrath, J., Olson, J.K., Skillen, D.L., Boman, J., et al. (2005). An inventory of nursing education research. International Journal of Nursing Education Scholarship, 2(1), Article 11. Retrieved July 12, 2005, from http://www.bepress. com/ijnes/vol2/iss1/art11
Conclusion
A highly effective technique for mastery of knowledge is to learn by doing (Becker & Neuwirth, 2002). The capstone teaching project described in this article enables students to apply
