Jie-hui Xu

Breast Surgery，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China

Review article

Toolbox of teaching strategies in nurse education

Jie-hui Xu

Breast Surgery，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China

A R T I C L E I N F O

Article history：

Received 3 February 2016

Received in revised form

24 February 2016

Accepted 16 March 2016

Available online 17 June 2016

Teaching strategies

Nurse education

Simulation

Jigsaw classroom

Concept mapping

Role play

Debate

Problem-based learning

There are a variety of teaching strategies that instructors can use to improve student learning.It is of great importance to select appropriate teaching strategies in nurse education to make the training more appealing and more effective.

In this article，ten teaching strategies will be introduced to help instructors learn how to involve the teaching strategy in the nurse education.If using these strategies well，students are more likely to memorize the information associated with the lesson.Selection of teaching strategies appropriately is of great importance for nurse educators to deliver high-quality education.

©2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

1.Introduction

Selection of teaching strategies is a fundamental component of instructional design.The goal is to help students process information more deeply，which allows them to relate new information to existing ideas or experiences.1Therefore，10 simple but useful teaching strategies will be introduced in the following.

2.Strategies

2.1.Strategy one：lecture

Of the many teaching strategies available in classroom teaching，the oldest and most widely used method today is the lecture. Lecturing is a straightforward way to impart knowledge to students quickly.

The lecture has many advantages，including the ability to provide information to a large number of students and cover a large amount of material quickly，while using class time efficiently in acost-effective manner.2The lecture is a way to introduce new material，continue discussion on a topic，and sum up course content，as well as presentlargeblocks of complex and confusing information.3However，some people believe that lecturing is ineffective as an instructional method.They feel that lecturing gives the students a passive，non-thinking，information-receiving role，through which they are exposed to information but are not given the opportunity to process it.4

Although the lecture seems to be a somewhat boring teaching method，it is still the most basic teaching strategy for instructors. With the development of technology，the lecture can be combined with a variety of other techniques，for example，Prezi presentation software，videos，and the Poll Everywhere application.Not only can this kind of combination attract students'attention，but it can also make the lecture a lot of fun.

2.2.Strategy two：high-fidelity simulation

Simulation，the art and science of recreating a clinical scenario in an artificial setting，hasbeen animportantaspect of nursing program curricula for decades.5In particular，high-fidelity simulation is useful for creating realistic scenarios that mimic the patient care environment and allow for more direct application of theoretical knowledge than is possible through traditional teaching methods.6

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2095-7718/©2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http：//creativecommons. org/licenses/by-nc-nd/4.0/）.

Simulation provides innovative educational experiences that help nurses assess and develop clinical competency，promote teamwork，and improve care processes in a realistic and relatively safe environment without the potential of harm to patients.7Simulation often emphasizes the application and integration of knowledge，skills，and critical thinking.8Smith&Roehrs have demonstrated in 2009 that using high-fidelity simulation could improve student satisfaction and self-confidence.9

High-fidelity simulation is a fantastic strategy for teaching clinical practice skills.It offers an opportunity to broaden students' understanding of diverse clinical scenarios in a safe and controlled environment.A debriefing session is imperative after simulation to improve critical thinking and clinical reasoning.

2.3.Strategy three：concept mapping

Concept mapping is a technique that allows students to understand the relationships between ideas by creating a visual map of the connections.10Concept maps allows the student to see the connections between ideas that they already have；connect new ideas to their existing knowledge；and organize ideas in a logical，but not rigid，structure that allows new information or viewpoints to be included in the future.11

Mapping procedures have been found to motivate students to represent ideas visually，thus causing them to analyze，evaluate，and think critically.12The goal of this strategy is for the student to learn through actively connecting new concepts to existing concepts.13Accordingly，the concept mapping helps complete missing knowledge，clarify existing knowledge，and improve critical thinking.In terms of nursing education，concept mapping is a great strategy for teaching clinical care planning.Concept mapping ofclinicalproblemsallowsstudentsto see interrelationships in clinical data and grasp a patient's total clinical picture.In this case，students do not need to copy the care plan from the textbook any more.They have the ability to explore a specific care plan for every patient by using concept mapping. Particularly，many concept mapping applications，which are convenient to use，are available on mobile devices，such as the bubll.us app.

2.4.Strategy four：online course

An online course does not have scheduled on-campus class meetings.It is an integrated learning program entirely accessible at any time and any place via a computer with an Internet connection.

Online education is widely accepted as student-centered education.To ensure the effectiveness of the online learning environment，instructors should create a detailed course plan，which includes selecting course materials and discussion topics，plus designing activities.14Online education provides increased flexibility，access，and cost-effectiveness in nursing education，because attending classes on campus is often difficult for nurses due to their work schedules and family and other responsibilities.

Online courses are an effective strategy for continuing education for nurses in clinical settings.The instructor should prepare diverse learning materials，such as literature，videos，websites，and discussion forums.Upon completion，an online test is required to evaluate comprehension.In this case，nurses are able to control their study time，and they also have time to absorb the materials.

2.5.Strategy five：games

Games are not only fun，but also an effective teaching strategy.15The use of games as a teaching strategy encourages involvement and increases both the motivation and the interest of the student. Games can make learning more enjoyable.

Nursing literature highlights many reasons for using games as a teaching strategy，including the promotion of active learning，encouragement of critical thinking，the value of fun and excitement in learning，and replication of real-life situations.16Using a game to teach content that may be considered dry or boring can bring about a fresh and enjoyable atmosphere.15Moreover，games combined with lectures are more effective than lectures alone in improving student knowledge.17

Of course，games may need to be combined with lectures in order to ensure a well-organized teaching environment.Games which can be played on a variety of mobile devices such as an iPad or smart phone are sure to make nursing education more interesting，engaging，and fun.

2.6.Strategy six：role playing

Role playing is a dramatization of an event or situation.The situation usually presents a problem or difference of opinion among two or more individuals，or circumstances that provoke anxiety.18It differs from other simulation-based learning activities in that it is unscripted.The learners act out a problem in a completely spontaneous manner.

In role playing the student represents and experiences a character known in everyday life.Role playing is a particularly useful strategy for practicing clinical communication skills and dealing with conflict.19Role playing can also be very effective for experiencing cultural principles and awareness because it allows students to become emotionally involved in cross-cultural learning and reflect upon cultural differences.20

Role playing can be used to teach communication in nursing education courses.At the beginning of a role playing activity，the activity's goal should be established.Also，the instructors need to communicate to the students in a situation or context for the interaction that will occur.Finally，debriefing is imperative for the instructor and students to discuss the situation and various perspectives of the individual characters.Debriefing also allows time to provide feedback to students.

2.7.Strategy seven：jigsaw classroom

The Jigsaw Classroom is a wonderful teaching strategy for cooperative learning.21This strategy，developed by Elliot Aronson，involves the formation of Home Groups to resolve a task.The Home Groups allocate one member to each Expert or Research Group，who gather data to bring back to the Home Group.

This cooperative learning technique reduces racial conflict among students，promotes better learning，improves student motivation，and increases enjoyment of the learning experience.22Thejigsaw processencourageslistening，engagement，and empathy by giving each member of the group an essential part to play in the academic activity.23

Concerning nursing education，the jigsaw classroom strategy can be used to teach the content of many topics in the classroom as well as in the workplace.The instructor needs to manage the process and provide a summary and debriefing session after study.

2.8.Strategy eight：case study

Case studies are stories.They present realistic，complex，and contextually rich situations，and often involve a dilemma，conflict，or problem that one or more of the characters in the case must negotiate.24

Case studies bridge the gap between theory and practice，and between the classroom and the workplace.25They also give students practice identifying the parameters of a problem，recognizing and articulating positions，evaluating courses of action，and arguing different points of view.24Hayward and Cairns state that the use of cases allows students to integrate and apply clinical and basic science knowledge and skills such as clinical reasoning，critical thinking，problem solving，and interpersonal ability to hypothetical or real case scenarios.26

The case study is a helpful strategy in nursing education.It can be used both in the classroom and online courses.It is also suitable for teaching about clinical diseases，culture competence，communication skills，and other topics.A summary or suggestion from the instructor is essential after study.

2.9.Strategy nine：debating

Debating is presenting the“pro”and“con”arguments of a specific assertion，proposition，or solution to a problem.27This teaching/learning strategy offers students an opportunity to learn new content in an exciting way.

Debating permits students to become actively involved in learning the course content while it promotes critical thinking and enhances verbal communication skills.28Also，debating triggers higher order learning，such as analysis，synthesis，and evaluation.29It can help students learn to both read and write critically.Bradshaw and Lowenstein claimed that debating is a useful teaching/ learning activity for nursing students at all levels.30

Debating can be used when teaching a controversial issue or discussing a trend in nursing education.All students are responsible for researching the issue being proposed.Debaters need to examine relevant literature，analyze the data，develop a solution or hypothesis，and present their ideas clearly and formidably during the debate.After the debate，the students in the audience evaluate the debaters'presentations and participate in post-debate discussion.This type of debate with feedback engages all the students in learning，improves team collaboration，and developscritical thinking.

2.10.Strategy ten：problem-based learning

The teaching method that uses patient situations or scenarios to stimulate students to acquire and apply information to solve problems is known as problem-based learning（PBL）.31Educators present realistic patient scenarios，ask questions，and require students to search for holistic answers.

PBL encourages active learning through self-directed learning，self-appraisal，clinical problem-solving skills，teamwork，discipline，and integration of information.32PBL also improves clinical reasoning skills，increases the retention of learned material，and enhances self-directed study.18

PBL is widely used for teaching a relatively complex or messy problem that has a broad association with basic science and clinical experience，such as heart failure or pneumonia.The instructor should manage the discussion process，give positive feedback，and conduct a summary.

3.Conclusions

Teaching strategies can engage students in an active learning process.If they use these strategies well，nursing students are more likely to memorize the information associated with the lesson.It is important for nurse educators to select appropriate teaching strategies in order to deliver high-quality education.

Conflicts of interest

All contributing authors declare no conflicts of interest.

1.Kemp JE，Morrison GR，Ross SM.Developing evaluation instruments.In：Designing Effective Instruction.New York，NY：MacMillan College Publishing；1994.

2.Morgan RL，Whorton JE，Gunsalus C.A comparison of short term and long term retention：lecture combined with discussion versus.J Instr Psychol. 2000；27：53.

3.Johnson JP，Mighten A.A comparison of teaching strategies：lecture notes combined with structured group discussion versus lecture only.J Nurs Educ. 2005；44：319-322.

4.Goodin HJ，Stein D.Deliberative discussion as an innovative teaching strategy. J Nurs Educ.2008；47：272-274.

5.Gomez GE，Gomez EA.Learning of psychomotor skills：laboratory versus patient care setting.J Nurs Educ.1987；26：20-24.

6.Nagle BM，McHale JM，Alexander GA，French BM.Incorporating scenario-based simulation into a hospital nursing education program.J Contin Educ Nurs. 2009；40：18-25.

7.Reese CE，Jeffries PR，Engum SA.Learning together：using simulations to develop nursing and medical student collaboration.Nurs Educ Perspect. 2010；31：33-37.

8.Kaddoura MA.New graduate nurses'perceptions of the effects of clinical simulation on their critical thinking，learning，and confidence.J Contin Educ Nurs.2010；41：506-516.

9.Smith SJ，Roehrs CJ.High-fidelity simulation：factors correlated with nursing studentsatisfaction and self-confidence.NursEducPerspect. 2009；30：74-78.

10.Carnegie Mellon University.Innovative Teaching Strategies；2006.2015.10.9. http：//www.cmu.edu/teaching/assessment/howto/assesslearning/ conceptmaps.html.

11.All AC，Huycke LI，Fisher MJ.Instructional tools for nursing education：concept maps.Nurs Educ Perspect.2003；24：311-317.

12.All AC，Havens RL.Cognitive/concept mapping：a teaching strategy for nursing. J Adv Nurs.1997；25：1210-1219.

13.Harpaz I，Balik C，Ehrenfeld M.Concept mapping：an educational strategy for advancing nursing education.Nurs Forum.2004；39：27-30，36.

14.Karaman S，Kucuk S，Aydemir M.Evaluation of an online continuing education program from the perspective of new graduate nurses.Nurse Educ Today. 2014；34：836-841.

15.Masters K.Development and use of an educator-developed community assessment board game.Nurse Educ.2005；30：189-190.

16.Glendon K，Ulrich D.Using games as a teaching strategy.J Nurs Educ.2005；44：338-339.

17.Royse MA，Newton SE.How gaming is used as an innovative strategy for nursing education.Nurs Educ Perspect.2007；28：263-267.

18.University of New Mexico.Teaching and Learning Strategies.2015.10.9.http：// nursing.unm.edu/resources/teaching-and-learning-strategies.html.

19.Shearer R，Davidhizar R.Educational innovations：using role play to develop cultural competence.J Nurs Edu.2003；42：273-276.

20.Kodotchigova MA.Role play in teaching culture：six quick steps for classroom implementation.Internet TESL J.2002；8：10-12.

21.Lai C，Wu C.Using handhelds in a Jigsaw cooperative learning environment. J Comput Assist Learn.2006；22：284-297.

22.Jigsaw Classroom.The Jigsaw Classroom Overview.2015.10.19.https：//www. jigsaw.org.

23.Jigsaw strategy.Pennsylvania State University；2007.2015.10.19 https：//www. schreyerinstitute.psu.edu/pdf/alex/jigsaw.pdf.

24.Case Studies.Carnegie Mellon University.2015.10.19.https：//www.cmu.edu/ teaching/designteach/teach/instructionalstrategies/casestudies.html.

25.Barkley EF，Cross KP，Major CH.Collaborative Learning Techniques：A Handbook for College Faculty.San Francisco，CA：Jossey-Bass；2005.

26.Hayward L，Cairns M.Physical therapist students'perceptions of and strategic approaches to case-based instruction：suggestions for curriculum design.J Phys Ther Educ.1998；12：33-42.

27.Garrett M，Schoener L，Hood L.Debate：a teaching strategy to improve verbal communication and critical-thinking skills.Nurse Educ.1996；21：37-40.

28.Darby M.Debate：a teaching-learning strategy for developing competence in communication and critical thinking.J Dent Hyg.2007；81：78.

29.Park C，Kier C，Jugdev K.Debate as a teaching strategy in online education：a case study.Can J Learn Technol.2011；37：17-20.

30.Bradshaw MJ，Lowenstein AJ.Innovative Teaching Strategies in Nursing and Related Health Professions.Sudbury，MA：Jones and Bartlett Publishers；2011.

31.Problem-based Learning.Stanford University；2001.2015.10.19 http：//web. stanford.edu/dept/CTL/cgibin/docs/newsletter/problem_based_learning. pdf.

32.Baker CM.Problem-based learning for nursing：integrating lessons from other disciplines with nursing experiences.J Prof Nurs.2000；16：258-266.

How to cite this article：Xu J-h.Toolbox of teaching strategies in nurse education.Chin Nurs Res.2016；3：54-57.http：//dx.doi.org/ 10.1016/j.cnre.2016.06.002

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Peer review under responsibility of Shanxi Medical Periodical Press.