Nurse Educator

A Systematic Process for Evaluating Teaching

Methods in Nursing Education
Eileen J. B. Thrower, PhD, APRN, CNM, CNE, FACNM;
Rebecca Fay, DNP, APRN, CNM, WHNP-BC, CNE, FACNM; Linda Cole, DNP, CNM, CNE, FACNM;
Vicky Stone-Gale, DNP, APRN, FNP-BC, FAANP; Angela Mitchell, DNP, MSN, FNP-BC;
Erin Tenney, DNP, CNM, WHNP; Sarah Smith, DNP, APRN, CNM;
and Charlotte Swint, DNP, MPH, FNP-BC, CNRN

ABSTRACT
Background: An evidence-based process for the evaluation of teaching methods in nursing education, including classroom as-
signments, is not well described in the literature.
Problem: Nurse educators are familiar with evidence-based teaching but may be less knowledgeable about evidence-based
methodologies to evaluate the effectiveness of teaching methods. Global measures of students' success, such as passing a licens-
ing or certification examination, are often used as benchmarks for nursing education programs.
Approach: The authors suggest an evidence-based, 8-step evaluation process for evaluating the effectiveness of teaching methods.
This process is demonstrated using simulation learning experiences in 2 courses in an advanced practice nursing education program.
Outcomes: The 8-step evaluation process was found to be effective for evaluating teaching methods within a graduate-level nurs-
ing education program.
Conclusions: The proposed evaluation process is applicable for evaluating teaching methods at all levels of nursing education.
This systematic evaluation of teaching methods may ensure that students are engaged in learning activities leading to the attain-
ment of assignment and course objectives.
Keywords: evaluation of teaching methods, evidence-based evaluation, nursing education, teaching methods

Cite this article as: Thrower EJB, Fay R, Cole L, et al. A systematic process for evaluating teaching methods in nursing education. Nurse Educ.
2020;45(5):257-260. doi: 10.1097/NNE.0000000000000761

N
urse educators face the challenge of adapting and called for nurse educators to employ evidence-based teach-
evaluating their teaching methods to prepare nurses ing (EBT) methods and have identified competencies for
for future innovations in health care. Each teaching nurse educators.1 However, the evidence used to guide
method used in nursing courses should facilitate higher-level and evaluate teaching methods in nursing education re-
learning, critical thinking skills, and real-world application mains unclear.2 Nurse educators may be familiar with
of knowledge. However, effective approaches to evaluating EBT strategies but not as familiar with evidence-based ap-
teaching methods and assignments in nursing courses are not proaches to evaluation of their teaching methods and
well described in the literature. Innovative teaching methods assignments.2,3
used by nurse educators are seldom formally evaluated. Teaching methods and assignments in nursing educa-
tion should lead to the attainment of course outcomes as
Background well as preparation for future clinical practice. With this im-
The science of nursing education has garnered much atten- perative in mind, nurse educators often use interactive
tion in the literature over the past several years. Experts have learning strategies such as e-learning, concept mapping,
internet-based learning, web-based distance learning, edu-
cational gaming, computer-based gaming, problem-based
Author Affiliations: Assistant Professors (Drs Thrower, Fay, Cole, and Smith)
and Instructor (Dr. Tenny), Midwifery and Women's Health; Assistant
learning, and case studies to increase student knowledge.4
Professor (Dr Stone-Gale), Instructor (Dr Mitchell), and Associate Professor Nurse educators who are knowledgeable about effective
(Dr Swint), Family Nursing, Frontier Nursing University, Hyden, Kentucky. EBT strategies may be more apt to use them, especially if
The authors declare no conflicts of interest.
they work in a system that supports innovation. Student
Correspondence: Dr Thrower, 174 Old Stagecoach Rd, Carrollton, GA 30116
([Link]@[Link]).
grades, student progress, national certification data, and
Accepted for publication: September 16, 2019 course evaluations are often used to evaluate teaching
Published ahead of print: December 3, 2019 methods.2 Nurse educators may also develop tools for eval-
DOI: 10.1097/NNE.0000000000000761 uating EBT.2-5 However, the evidence is limited related to

Nurse Educator • Vol. 45 • No. 5, pp. 257–260 • Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. [Link] 257

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

evaluating the effectiveness of teaching methods and assign- the evaluation tool should be considered, and authorization
ments within courses. to use the tool should be obtained. If an appropriate tool is
A group of nurse educators in a graduate-level program not available, it may be necessary for the nurse educator to
had the opportunity to reflect on the innovations made in create or modify a tool. Because of the added time needed
their teaching methods asa response to the changesin health to establish validity and reliability for a new tool, it is often
care and clinical practice. The educators expressed concern preferable to identify an existing tool. A literature review
related to the lack of an evaluation process for innovative using terms such as instructional design, course evaluation,
changes in teaching methods. They worked together to or evaluation tools can facilitate the identification of an ap-
identify an effective process for evaluating the use of teach- propriate tool.
ing methods. After conducting a literature review, an evalu- The next step in the evaluation process is data collection
ation process was proposed. The process was then applied using the chosen evaluation tool. Data collection is guided
as innovations were made in teaching methods in 2 ran- by available resources, the scope of the change imple-
domly selected courses. In both courses, simulated learning mented, the number of students involved, and students'
experiences were employed to teach advanced practice nurs- characteristics. Appropriate sample size should be deter-
ing students, replacing more traditional teaching methods mined based on the intended power of the evaluation. In
and written assignments. This article presents an 8-step pro- some situations, all the students involved might be sam-
cess for evaluating teaching methods and demonstrates pled; in others, a representative sample may be chosen.
the use of this evaluation process in 2 graduate-level nurs- Data should be organized and analyzed appropriately
ing courses. to answer the evaluation question as part of the fifth step
in the process. The demographic and student-characteristic
Evaluating Teaching Methods data should be organized to provide contextual under-
In nursing education, innovative changes in teaching methods standing in the evaluation process. The need for institu-
within a course are frequently made without a plan for tional review board approval should be considered before
formal evaluation. Bourke and Ihrke6 identified 10 steps the evaluation process is implemented.
to evaluate outcomes at the classroom, curriculum, or Results are sharedwith the faculty team, as the next step,
program level. These 10 steps can be modified to meet based on evaluation findings. If changes to the curriculum
the needs of evaluation in nursing education. Eight of are deemed necessary, results should be shared with the ap-
the 10 steps are applicable for evaluating innovative ap- propriate institutional curriculum leaders. The final, and
proaches in teaching methods and assignments, based perhaps most important, step in the evaluation process is
on Bourk and Ihrke's work.6 using the findings. The results of the evaluation process
The purpose of evaluating teaching methods within a should be thoughtfully applied for continuous improve-
course will vary depending on the course, teaching methods, ment in the nurse educator's teaching methods and the de-
and assignments that are used. The first step in the evalu- sign of course assignments. Evaluation of teaching methods
ation process is to determine its purpose; then, evaluation is an iterative process of ongoing improvement analogous
questions can be identified. The evaluation questions may to quality improvement. Nurse educators should be ac-
relate to student outcomes, student engagement, student tively encouraged to disseminate their findings so that other
learning, student satisfaction, or test scores. The evalua- nurse educators might benefit from lessons learned.
tion can also address educator outcomes, such as the
experience of completing the instruction. The purpose Application of Evaluation Process 1: Peer
of evaluating teaching methods and assignments should Review Simulation
be focused and specific. A simulated peer review experience was developed for an
The second step in the evaluation process is to determine advanced role course in a graduate nursing education pro-
when to evaluate. Both formative and summative evalua- gram. The students reviewed the compliance of advanced
tions are needed to guide modifications of teaching methods. practice nurses' implementation of a health care screening
Although repeated evaluations are time-consuming for guideline in a clinical setting. Students reviewed the compli-
educators, they provide critical information about the value ance data before the simulation experience. During the
of the teaching methods or assignments. online simulation, the students were randomly assigned to
Choosing an evaluation design, frame, or model is the pairs, where one was a peer reviewer and the other was
third step in the process. The model chosen should be appro- an advanced practice nursing leader within a health care
priate to answer the evaluation questions. Institutional cur- system. Communication using principles of just culture
ricular strategies should be incorporated into the design of was stressed. All the students participated in a debriefing
an evaluation process or tool. session immediately following the simulation.
Choosing an appropriate instrument is the fourth step
in the evaluation process. A variety of tools for evaluating Evaluation of the Peer Review Simulation
teaching methods can be found in the literature. The tools Faculty conducted a literature search to identify validated
include questionnaires, interviews, rating scales, checklists, instruments designed to measure student learning out-
attitude scales, and portfolios. The reliability and validity of comes. Without a baseline comparison group, a validated

258 Nurse Educator • Vol. 45 • No. 5. [Link]

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

instrument was thought to be necessary. Several instru- options. Student nurse practitioners may not have the
ments were compared to determine relevance to the appropriate answers for the patient and were cautioned to
elements of the simulation content and design. The Simu- avoid giving erroneous information. Interprofessional col-
lation Learning Effectiveness Inventory (SLEI),7 a vali- laboration was explored as care of the patient was trans-
dated instrument for measuring learning outcomes in ferred to a specialist. The concepts of patient-centered care
simulations, was chosen as the best instrument. The in- and shared decision making were also incorporated in the
strument was modified for the assignment, with permis- simulation. Debriefing sessions with patients and faculty
sion from the instrument's author. The SLEI explores 7 provided a safe environment for students to analyze and
domain areas, including course arrangement, equipment share their feelings and to discuss communication and tran-
resource, debriefing, clinical ability, problem solving, sition techniques.
confidence, and collaboration.
Faculty identified the purpose of the evaluation to be Evaluation of the Difficult Conversations
the appraisal of student learning from the peer review simu- Simulation
lation assignment, as this assignment was a new means of The purpose of the evaluation was student-focused. An
teaching peer review. It was hypothesized that simulating understanding of how students learn about their scope of
the peer review process would provide a meaningful ap- practice and become cognizant of feelings and emotions
proach to synthesis-level learning. Students completed regarding breaking bad news was sought. Students were re-
an electronic survey, which provided them with the op- quired to submit a 2- to 3-page reflection of the simulation
portunity to reflect on their learning. Completion of the and debriefing experience within 3 days of completing the
simulation evaluation, using the SLEI, was encouraged activity. This time frame was chosen so the full effects of
immediately following the simulation to ensure maximum the simulation would be present. The reflection allowed stu-
recall of the experience. dents to examine their own emotions, feelings, and experi-
Data collection began as soon as the first group of stu- ence in breaking bad news. It was hoped that students
dents completed the simulation and debriefing experience. would be honest and examine their strengths and weak-
A total of 39 questions using a 5-point Likert scale were in- nesses during the simulation.
cluded as well as an area for additional narrative comments. Students also completed a Learning Experience Evalu-
Interpretation of the data began at the end of the first aca- ation tool that examined learning outcomes. The Learning
demic term the assignment was used. Both quantitative Experience Evaluation was developed by the simulation
and qualitative data were examined, and a report was com- team at the university to assess prebriefing orientations,
piled to summarize the findings. The evaluation results were the effectiveness of objectives, application abilities, time
shared with the university's simulation team as well as with commitment required, level of assignment difficulty, and
course faculty to increase understanding of the students' debriefing activities. Students and standardized patients
perception of teaching outcomes from the simulation. were given an opportunity to provide qualitative feedback
Course faculty then used the findings from the SLEI to mod- to the assignment. The standardized patients were provided
ify the simulation assignment to improve learning outcomes with specific criteria used to score the students.
for future students. Results of the evaluation process were Data collection began immediately after the simulation
presented to nurse educators to share the experience and and debriefing sessions were completed. The Learning
lessons learned. Experience Evaluation tool was sent to students via email.
The standardized patients completed scoring sheets and
Application of Evaluation Process 2: Difficult provided qualitative information on each student immedi-
Conversations Simulation ately after the session was completed.
A second simulation assignment was developed for an Course faculty used findings from the Learning Evalu-
online primary care management course. The SPIKES ation Experience and the qualitative data to guide contin-
protocol (Set the stage, Perception, Inform, Knowledge, uous improvement in the assignment. Dissemination of
Empathy, and Summarize)8 was used as nurse practitioner findings from this evaluation process will increase nurse
students simulated breaking bad news to patients regard- educators' understanding of student perceptions regard-
ing a life-changing diagnosis. Standardized patients were ing breaking bad news to patients.
used in the simulation to provide firsthand experiences
with communication techniques. Students were presented Outcomes
with a scenario requiring communication of the diagnosis The Peer Review Simulation assignment was evaluated with
of malignant melanoma. The standardized patients had the SLEI and indicated that more than 96% of respondents
been instructed beforehand to react in various ways, pro- (n = 800) agreed or strongly agreed that the assignment con-
viding students with the opportunity to reflect on their tributed to their learning in all 7 domains of the SLEI. The
emotions and feelings related to presenting bad news. Difficult Conversation: NP Scope of Practice Across Care
During the assignment orientation, the students were Transition simulation assignment was evaluated using an
instructed to be aware of their scope of practice when pro- electronic survey. The respondents (n = 462) strongly
viding information to the patient regarding treatment agreed that the activity was a positive learning experience

Nurse Educator • Vol. 45 • No. 5. [Link] 259

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

(93.43%) and that they were able to apply the content success in nursing practice. Although warranting further re-
learned in the course during the activity (95.55%). They search, engaging in a systematic approach of evaluating
also agreed the standardized patients were professional, teaching methods in nursing courses will likely lead to im-
acted in character (82.00%), and provided constructive provements in meeting course objectives and in maximizing
feedback during the debriefing session (83.37%). The qual- student learning.
itative data provided by the students confirmed that this
was a valuable learning experience.
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TEACHING TIP
The Report Game: An Effective Tool in
Postconference Reporting

A communication strategy, inspired by the telephone game, was introduced into a postconference for nursing students
in their first clinical course to improve communication techniques in end-of-shift handoff reports. This was an effective
strategy to teach students the importance of clear communication while prioritizing important information. At the end of the
clinical day, students were placed in pairs to give report on the client they had cared for during the clinical day and receive
report on the other student’s client. Students were given 3 minutes each to complete their report. After the 3 minutes, new pairs
were formed, and the students communicated the received report to their new partner. Again 3 minutes were allotted for
each student to communicate priorities and important information. After the second team completed their reports, random
students were selected to give report to the entire group, and the student who cared for the patient revealed if any valuable data
had been lost or if extraneous information was added. The telephone game illustrates the problem with handoffs and reinforces
the importance and relevance of capturing information. Students evaluated the activity as increasing their confidence and
stating they were more equipped to give an end-of-shift report to a primary nurse.

By Andrew J. Donadio, DNP, RN-BC, CNE, Assistant Professor; and Shelia Hurley, PhD, RN, MBA/HC, Associate Professor, Tennessee Tech University,
Cookeville TN,Adonadio@[Link].
DOI: 10.1097/NNE.0000000000000809

260 Nurse Educator • Vol. 45 • No. 5. [Link]

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