Thursday, 25 July 2019: 2:30 PM
Purpose:
Per the mission of National Council of State Boards of Nursing (NCSBN) Next Generation National Council Licensure Examination (NCLEX), nurse educators need to increase diversity of pedagogical approaches to cultivate reflection, critical thinking, and communication skills among baccalaureate nursing students to improve their readiness for practice. Arts-based Pedagogy (ABP) is a teaching methodology in an art form, student created, is integrated with another subject, nursing concepts, to impact student learning outcomes.
The purpose of this study was to determine the impact of ABP, on nursing students’ observational, communicative, and reflective clinical practice skills. Also, student satisfaction with learning via two specific ABP activities used in this study was generally evaluated for use in future courses within the school’s program. In this study, undergraduate nursing students completed arts-based course assignments depicting either their personal nursing metaparadigm or their definition of family, depending on their level of study within the nursing program.
Methods:
In this study, 166 students who were in their upper levels of undergraduate baccalaureate courses studying nursing theories and ways of knowing and care of families were asked to participate in a graded homework assignment as part of their course assignments.
To determine how nursing students understood nursing theory and ways of knowing, students were asked to create a mandala based on the nursing metaparadigm. A mandala is a reflective tool for the development of a students’ personal path of knowing specific to the discipline of nursing. The mandala, as an ABP assignment, required students to surface their knowledge of the nursing metaparadigm via their own interpretation using a unique design, chosen symbols, and colors having personal meaning and relevance to each of the four concepts: patient, health, nurse, and environment. Importantly, this assignment provided a space for students to contemplate the fusion of their personal and professional selves through reflection upon theory and evidence, as well as their personal values, beliefs, and historical and new understandings about nursing. In addition to creating the mandala art, the assignment also required students to write an 800 word (or less) scholarly paper describing, analyzing, interpreting the components of their mandala, and reflecting upon the experience of creating it.
To determine how nursing students define family, this study called on students to create a work of art that symbolized and represented family to them. The student who created the work of art observed while the rest of the class discussed their creation in the classroom. The faculty member used ABP to discuss the student’s creation. In this study, ABP included a student-centered facilitated discussion using Visual Thinking Strategies (VTS) as a framework for three questions based on about each work of art; 1. What is going on here? 2. What are you seeing that makes you say that? And 3. What more can you find? (Moorman, M. & Hensel, D., 2016).
Students engaged in discussions about each work of art during class.
Together, after all students completed respective course assignments, they were asked to complete six questions in an anonymous Qualtrics survey about their experience. Survey questions included:
1. Were you aware of arts-based teaching-learning strategies before this class?
2. What did you think of creating a work of art (visual representation) for this class?
3. What impact did the arts-based assignments have on your observational skills?
4. What impact did the arts-based assignments on your communication skills?
5. What impact, if any, did this arts-based assignment have on your future clinical
practice? And
6. Would you participate in a similar activity in the future?
Analytic procedures were completed using qualitative content analysis to identify categories of data that emerged into reflective themes (Hsieh & Shannon, 2005). IRB approval was obtained prior to data collection from the Northwestern University. No incentives were provided for participation. Demographic data was not collected on participants.
Results:
Of the eligible 166 students, 89 students (53.6%) participated in the study. Of the participating students, more than half (n=51 or 57%) were not aware of arts-based teaching-learning strategies before this project. All but seven students reported they would participate in similar learning activities in the future (n=80 or 91.9%). Supporting statements included: “I like the challenge of thinking outside the box,” “Absolutely. I have a whole new respect and admiration for my colleagues,” and “…great practice to enhance my communication skill, I am noticing small details.” Reasons for not wanting to participate in similar learning activities included: “I would rather write something or use a different technique if possible,” and “Maybe I would do arts and crafts in my free time because it is fun and relaxing, but I would prefer not to be graded on something like [that].” Identified themes regarding students’ perceptions of creating a work of art included: thinking deeply, demonstrating creativity, and engaging. Identified themes regarding students’ perceptions of impact of ABP on observational skills included: noticing differences, context matters, and synthesizing course concepts. Identified themes regarding students’ perceptions of impact of ABP on communication skills included: thinking about learning more deeply and abstractly, verbalizing emotions, and an overall increase in confidence.
The essential question regarded perceptions of ABP’s impact on future clinical practice. Most students (77.5%) reported that ABP would impact their future clinical practice (n=62 yes) while 22.5% (n=7 unsure, n=11 no) were not sure or did not think that ABP would impact their future clinical practice. Supportive statements included “Better critical thinking and broadening of ideas to gain and better understand a more holistic picture,” and “It will allow me to seek other, not traditional/medical, ways of engaging or utilizing clinical skills. Although, this won't necessarily help me learn how to put an IV in a patient, it helped me to build on looking at a whole picture or expanding my mindset to more than just the obvious.” Students who reported that ABP would have little to no impact on their future clinical practiced included statements such as, “I don't think there is a significant impact with how it'll affect my future clinical practices that are different from the standard style of learning through lecture and assignments.”
Conclusion:
This experience provides students with the opportunity to discuss and explore their personal nursing or their definition of family through ABP. Patient care can be enhanced when nurses have an awareness of their own values and beliefs, yet are simultaneously able to accept, with humility, that there are many other ways of knowing, or coming to know the world. Given the ever-changing landscape and complexities of the healthcare system, nurse educators ought to expand teaching methodologies that support the development of students’ critical thinking skills, enhancing their clinical judgment for practice. ABP is one innovative teaching methodology that increases students’ observation and communication skills, informs their clinical decision-making, and thereby potentiates satisfying client experiences and improved health outcomes.