I have been asked to summarize what I have done this term to help my students prepare for the NCLEX at a faculty meeting on Wednesday. Typically the theoretical courses that I teach may not be not seen as predictive of NCLEX success. For a class like research, in particular, it may be more challenging to see the connection. However, all courses in a nursing program help to prepare students with critical thinking skills. Several strategies were implemented in both my Research and Teaching and learning classes to explicitly promote NCLEX success. It is hard to say what has worked or not yet, but overall it felt like a successful term.

Relationship Building

How and why open, honest, and respectful professional relationships are important is a topic for another post. However, it is worth noting that I do not think that any of the strategies described below would have been effective if we did not first develop a shame and blame-free environment for learning (Registered Nurses Association of Ontario, 2012).

In this post, I talk about how Bitmojis helped to improve engagement.

Needs Assessment

Assessing learner needs is critical if you are going to meet them. Every class has unique needs, barriers to learning, and desires. Several strategies were used to assess what they needed to learn, including collaboration with others and a learning plan assignment (described below). In addition, a learner preferences survey based on the universal design for learning framework and exit tickets were used to gauge student needs and preferences. It was critical that I listened to them in class to find out what they needed.

Collaboration

Ongoing communication with colleagues to assess student needs was extremely helpful. Before and during the term I listened to what other faculty observed as areas for growth. In particular, I listened to where they struggled in their practice course and tried to bring in theory in my courses to support what they were learning in practice. For example, I deliberately talked about how to prioritize breathing concerns in my course the week after they had a hard time with a case study in another course.

Students were doing very well in the research class at Midterm. Because of their success, I was able to emphasize learning outcomes in the course that connected research and theory to practice. When adding more theory to my class in an effort to support the practice teachers I sent out an email asking for input from all faculty. Those that responded helped me select specific theory to emphasize in relation to praxis.

How I brought prioritization, delegation, and assignment into the research course.

Discussed Concepts and Theory for Prioritization

In the past, the discussion of theory and how it guides practice has been more general than this year. Both students and faculty identified that students needed more understanding of prioritization and delegation principles. In response, I asked students to read the first chapter of LaCharity, Kumagai, and Bartz (2019), which I was able to post on Moodle. I also encouraged students to purchase the textbook and practice questions. Then, in alignment with my course outcomes, we talked a lot in class about how concepts and theory impact the prioritization of client needs in practice.

Prioritization slide. We talked about how conceptual frameworks guide practice.

Students told me that they were confused about how ABCs (Airway, Breathing, and Circulation) should be used. They said that in the second year the ABCs were stressed but now they were being told that ABCs do not always work. LaCharity et al. (2019) nicely explained how ABCs and Maslow’s should be used as a guide (not a rule).

When designing my class I also talked to praxis teachers to see how they taught prioritization. Students were already confused and I wanted to make sure that my teaching would be consistent with theirs. It was very helpful to have communication with these other teachers to make sure we were delivering a consistent message.

Maslow’s Hierarchy with the three levels of priority setting on top.

We used Mentimeter a lot to reinforce the conversation. For example, we worked through some examples of how to prioritize client needs. I think that interactive methods and application activities helped to reinforce the content they were being asked to understand.

Universal Design for Learning

In the teaching and learning course, I talked about how universal design for learning was used to inform the development of the course. Where possible, I provided alternative approaches to readings. Because learners need things explained in multiple ways and not everyone learns best by reading I recommended videos like the one below to reinforce teaching where possible.

Mentimeter

Students report that the use of Mentimeter in class is the most helpful strategy. Obviously, Mentimeter is not the only tool that allows for live polling of the audience. The types of questions I can ask in Mentimeter and the leaderboard function seems to have worked well for the needs of my students – who have told me that they are competitive.

Students say that seeing how everyone answered and hearing the explanation, rationale, and test-taking strategies were useful for their learning.

The process used in class with Mentimeter Questions. First, they answered the question then we talked about the rationale.

Discuss Test-Taking Strategies

When using Mentimeter I have students answer questions first then we talk about what the correct answer is and why it is correct. Sometimes I explain the answer and other times I ask students to explain why the answer they picked was correct. Near midterm, there was a faculty meeting where it was identified that we do not talk enough in class about how to answer different kinds of NCLEX questions. I responded by talking about it in the teaching and learning class, putting some books on reserve, and talking about it in class with each Mentimeter question.

Screenshot of a Mentimter question at the Knowledge level.

With the question above we also started talking about what level of Bloom’s taxonomy the question was written at. I tried to show them an example of the same kind of question written at different levels.

Screenshot of the same question at a higher level.

For longer NCLEX style questions, I had to put them on a handout.

Discussed Bloom’s Taxonomy

Bloom’s taxonomy was talked about in both classes. In Teaching and Learning, it was discussed at the beginning of the class. After I took a course about how to write NCLEX questions I started explicitly talking about it more in class, emphasizing that on the NCLEX they would see application and analysis level questions not knowledge and comprehension questions. I also summarized my lessons from the NCLEX course for them in an optional discussion in the teaching and learning course.



The NCLEX tests competence based on the dififculty of questions NOT the number of questions answered corectly.
It is fundamentally different than exams in school.

Research

For an assignment I had them read and table articles about the NCLEX that talked about examine experiences and success strategies. I emphasized two main things: practice and hopeful thinking. They needed to look at 14 publications and identify the three that met the criteria for the literature review in the course. Hopefully, reading articles about NCLEX prep had them buy-in to the need to start studying soon. The three that they tabled are listed below.

Hanson-Zalot, M., Gerolamo, A., & Ward, J. (2019). The Voices of Graduates: Informing Faculty Practices to Establish Best Practices for Readying NCLEX-RN Applicants.Open Journal of Nursing, 9(2), 125โ€“136. https://doi.org/10.4236/ojn.2019.92012
March, A. L., & Robinson, C. (2015). Assessment of high-stakes testing, hopeful thinking, and goal orientation among baccalaureate nursing students. International Journal of Nursing Education Scholarship, 12(1). https://doi.org/10.1515/ijnes-2014-0075
McGillis Hall, L., Lalonde, M., & Kashin, J. (2016). People are failing! Something needs to be done: Canadian studentsโ€™ experience with the NCLEX-RN. Nurse Education Today, 46(Complete), 43โ€“49. https://doi.org/10.1016/j.nedt.2016.08.022

Anecdotally, students told me it was an activity that convinced them to buy NCLEX prep material that other teachers were recommending. We talked about how the NCLEX has improved since 2015, that people do fail, what strategies have been researched to promote success (like practice), and the role of positive thinking in influencing their success.

Building Confidence

I strategically tried to build their confidence throughout the term. Too often we emphasize student areas for growth in a negative way. Human beings respond better to feedback that is more positively framed. When talking to my students I try to emphasize what they are good at. We talked about the need to build confidence in both classes in relation to how we give feedback to clients as well as receive it.

De-emphasized Grades

I graded students, but I also talked about how grades are problematic. Then we talked about how standardized testing is used for the NCLEX. I think emphasizing with them then talking about how to deal with the reality of the NCLEX helped to make them open to studying.

Class Discussions

In both courses, I talked about the NCLEX where it fit. Teaching and learning, in particular, is an integrated process. Every week the NCLEX was discussed in one way or another.

Explicit connection of Research to the NCLEX.
Explicit connection of Teaching and Learning to the NCLEX.

Learning Plan

In the teaching and learning course, students created a learning plan. They co-created the assignment expectations and required learners to explicitly connect the plan to the NCSBN test plan. This assignment helped me see what their needs were and promote self-directed preparation for the NCLEX.

In the past, this activity was done in class and evaluated based on a pass/fail basis. It was also not done about the NCLEX. This term it was only worth 2%, which was a mistake. A few students did not do it. I had a hard time seeing the alignment to my course outcomes, which is why I weighted it so low. However, I can adapt them for the next delivery as I think it should be weighted higher as it is a valuable activity that the students will carry into future terms. Next term they take the learning plan to the next level and it is weighted higher.

Discharge Teaching Assignment

Other faculty in my program developed a list of topics for students to use in my Teaching and Learning course. Each topic was designed to improve their preparation for the NCLEX. The intent was made explicit in the course syllabus ” This assignment is designed to aid the audience in their preparation for writing the NCLEX.” Moreover, the students co-constructed the expectations for this assignment. I think it was an overall success, but can be improved for future use.

Transparency

I think it is really important to be transparent with students about what you are doing and why. In my syllabus and course activities, I explain why I am doing what I am doing (not just what). I think that helped them engage. Motivation is connected to one’s perceived competence, autonomy, and relatedness in self-determination theory (Gillison, Rouse, Standage, Sebire, & Ryan, 2019). By explaining how activities are related to their success on the NCLEX it makes sense that they would be more motivated to engage.

Honesty

I got a lot of questions about the NCLEX. I answered them honestly and referend to research when possible. Many questions about why Canadian pass rates have struggled, why there is so much emphasis on the NCLEX in third year but not earlier years, and how they should prepare were asked. Students did not realize how recently the NCLEX came to Canada. They do not like the idea of needing to buy added resources but can understand why they are needed. Hopefully, that helps them.

Exam Feedback

I have always mapped questions to the learning outcomes in my course but I did not always tell students about it. In my open-book tests and PeerWise activity (as well as on the exam), I have started mapping my questions to the nursing process and Bloom’s taxonomy. Unfortunately, students only see this mapping after the exam is over. I like giving them immediate feedback because it reinforces learning. It is easy to do for multiple-choice exams in Moodle.

Question Mapping

After their teaching and learning open book exam I explained how I marked each question using a mail merge. Many of those questions were manually graded as the essay style questions were at the highest levels of Bloom’s: create and evaluate.

Shared Responsibility

I believe that talking about my teaching philosophy at the beginning of class and adopting a shared responsibility for learning really helped this term be successful. It was working collaboratively with students and other faculty that enabled improved integration of NCLEX prep in my courses. I hope that next term their teachers recognize the critical thinking ability of this group and challenge them with active learning strategies. I also hope Cambrian decides to fund tools like Mentimeter for more faculty.

Fun

This semester was a lot of work. However, it did not feel exhausting because I was doing my best and seeing the success of the students. I love my job. When I feel like I am doing my best it is almost like I am not working.

Did I miss something?

I feel like I may have missed something. Please comment below if you have any ideas I should add here. I might update this post before the meeting if I get some feedback from my students.

References

Gillison, F. B., Rouse, P., Standage, M., Sebire, S. J., & Ryan, R. M. (2019). A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective. Health Psychology Review, 13(1), 110โ€“130. https://doi.org/10.1080/17437199.2018.1534071

LaCharity, L. A., Kumagai, C. K., & Bartz, B. (2019). Prioritization, delegation, and assignment: Practice exercises for the NCLEX examination (4th ed.). Elsevier.

Registered Nurses Association of Ontario. (2012). Facilitating client-centred learning. Retrieved from https://rnao.ca/bpg/guidelines/facilitating-client-centred-learning


NurseKillam

Laura Killam is an experienced nursing educator from Northern Ontario with a keen interest in improving student learning through innovation. For more information please visit http://nursekillam.com/.

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