School of Nursing – Blended Practice-based Courses

The undergraduate curriculum in the School of Nursing was under substantive review to streamline and better coordinate the delivery of content throughout the program by means of introducing new teaching and learning strategies. The overall objective of the project was to offer students with improved flexibility in scheduling of in-class days as well as a variety of learning opportunities such as augmented reality laboratory simulations, web-based video clips, interactive online modules, hands on learning, and small group activities. Prior to this project, most nursing courses were taught in large face-to-face lectures. This project enabled faculty to “flip” up to 30% of this content, thus significantly reducing classroom time and allowing students and supervisors more flexible scheduling of clinical practice placements. The new curriculum delivery model was designed to link core clinical content within and across the curriculum, reinforcing and integrating critical theoretical concepts and skills. An added outcome of this project has been a culture change among faculty in the School of Nursing, who have now become proficient in designing, delivering and evaluating new teaching and learning approaches across the entire program.

Maura MacPhee, School of Nursing, Faculty of Applied Science
Bernie Garrett, Co-Principal Investigator / Associate Professor, School of Nursing
Cathryn Jackson, Co-Principal Investigator / Senior Instructor, School of Nursing
Khristine Carino, Flexible Learning Coordinator, School of Nursing
Marc Legacy, Teaching and Learning Fellow, School of Nursing
Joanne Ricci, Senior Instructor, School of Nursing
Ranjit Kaur Dhari, Lecturer, School of Nursing
Cathy Ebbehoj, Lecturer, School of Nursing
Farah Jetha, Lecturer, School of Nursing
Lynne Esson, Lecturer, School of Nursing
Elsie Tan, Senior Instructor, School of Nursing
Cheryl Segaric, Lecturer, School of Nursing
Lucas Wright, Learning Technology Specialist, Centre for Teaching, Learning and Technology
Namsook Jahng, Instructional Designer, Centre for Teaching, Learning and Technology
Adriana Briseño-Garzón, Flexible Learning Evaluation Coordinator, Centre for Teaching, Learning and Technology
Marcelo Bravo, VP Students Office
Katherine Lyon, VP Students Office

Products & achievements: Redesigned curriculum for practice-based courses; 12.5-100% reduced seat time in 11 courses with; lecture videos; online modules and module templates; worksheets and quizzes; common core health policy module; case studies; situated learning resources and activities; N344 synthesis project site; professional development sessions for faculty; student town hall meetings.

Intended outcomes/themes:

1. Redesigned curriculum within practice-based courses to reduce 12 hours of classroom time.
   • Increased flexibility on how, where and when students learn.
   • Increased flexibility in scheduling of in-class days and practicum placements.
   • More diverse and creative curriculum design.
2. Use and adapt situated learning resources across the program (simulations).
   • Better student preparation for clinical practice
3. Deliver professional development sessions to introduce faculty to new teaching strategies
   • Increased faculty expertise and confidence with new teaching strategies.

Evaluation approach: A mixed methods approach was used:

• Student focus group sessions and Town Hall
• Student Pedagogy Experience Survey (N336 and N337)
• Education research: Quasi-experimental design to compare student case discussions in traditional vs flipped class (N336); Student reflective practice assessment (N344)
• Informal feedback and reflections from faculty and community/practice partners.

Findings:

Student focus group sessions and Town Hall:

• Feedback indicated general student satisfaction with the FL initiative. Students found the online modules beneficial, freeing classroom time to be used at their discretion. They cautioned that online modules should be completed in the equivalent time than the pre-transformation in-class work.

Student Pedagogy Experience Survey:

• Students were overall satisfied with Flexible Learning and with the integration of technology.
• 90% of students felt part of a respectful learning community and were satisfied with their collaborative experience; 70% felt that working with others enhanced/supported their learning; 60% were able to develop new skills and knowledge as a result of student collaboration; 50% found collaboration helped them engage with course materials more deeply.

Education research:

• An analysis of student reflective writing indicates they valued/benefited from: flexibility (project schedules, project goals); autonomy (student independence, self-direction); technology (e-communications/ strategies, e.g. google docs); structures, processes, clear outcomes).
• The quasi-experiment showed that: students in FL condition engaged in deeper levels of discussion (analyzing/applying vs. recall/remembering); exam performance was comparable in both groups but FL students showed to be more creative and confident in presenting content in public; they benefited from multiple engagement with course materials.

Informal feedback from faculty:

• Overall satisfaction with online modules and resources that are now available for future use. However the up-front faculty work was very difficult to manage. They also appreciated the opportunity to review/discuss highlights with clinical instructors and found ease in updating online content and lighted workload after the initial time/work investment.
• Faculty found they made a more effective use of time: freeing up class time (three hours on-campus lectures) for one on one student consultation; in-class time is used to probe deeper learning.
• This project lead to a shift in teaching culture at the School of nursing. Faculty are now confident and comfortable about incorporating new teaching approaches/tools and recognize the benefits of using these. They are also receptive and responsive to feedback from students and peers and aware of the available resources on campus to help them achieve their teaching goals.
• Teaching practices have changed as result of this project. Faculty have replaced lecture style delivery content with active learning that challenges students to understand and apply the information in clinically based case scenarios or guiding questions. Changes are seen as sustainable over time.
• Students are better prepared for clinical practice and the client receives more comprehensive care.

Dissemination:

MacPhee, Dhari, Ricci, Carino (2016). Student-Faculty-Community Flexible Learning Partnerships. UBC Spring Institute 2016.

MacPhee, Carino (2016). Flexible Learning Initiative: School of Nursing Undergraduate Curriculum. UBC TELF Showcase 2016.

Dhari, Ricci (2016). Community Health Transformation: Success within an Accelerated BSN Program.  Nurse Educator Summit 2016, Nashville, TN.

MacPhee, Dhari, Ricci, Ebbehoj, Segaric (2016). Flexible Learning in Nursing, CASN Accreditation.

Bravo, Carino, Lyon, Briseno-Garzon, MacPhee (2015). Use of Reflection to Improve Student Metacognition about their Learning, STLHE 2015, Vancouver.

Garrett, Ricci, Carino, Jahng, Dhari (2015). Creating, Implementing and Evaluating Flipped Classroom E-Learning, STLHE 2015, Vancouver.

MacPhee, Ebbehoj, Dhari, Ricci, Segaric (2015). Flexible Learning in Nursing, UBC CTLT Spring Institute 2015.

MacPhee, Garrett, Jackson, Legacy (2014). Flexible Learning Innovations and Outcomes within an Undergraduate Nursing Curriculum, ISSoTL 2014, Quebec City.

Legacy (2014). Applications for Flexible Learning at UBC, EKM Forum 2014, UBC School of Nursing.

MacPhee (2014). Applications for Curriculum Redesign in the SoN, EKM Forum 2014, UBC School of Nursing.

Sustainability: Faculty development has been the greatest sustainability factor. With CTLT support, faculty members have learned how to create their own curriculum materials, and they are working together to provide more seamless delivery of content. Changes in our knowledge of patient/population needs, treatment strategies and healthcare systems are constantly changing. The FL project has enabled faculty to update and create new curriculum as needed—to keep with the fast-paced changes in health care. Our faculty members have the means, skills and confidence now to create and deliver undergraduate nursing curriculum that is truly flexible and adaptable to new learners.