Teaching Research to Graduate NursingStudents: A Strategy Using Clinically BasedResearch Projectsnuf_196 260..265

Jill Hamilton, PhD, RN

This article describes an approach toteaching advanced practice nursing studentsthe research process through the applicationof the research process to clinical problems.In the course, students propose solutions toclinically based research projects throughconceptualizing the problem, identifying anappropriate theoretical framework,conceptualizing the intervention or clinicalguidelines, and designing a project thatincludes the research design, samplingstrategies, procedures for implementation ofthe project, and plans for data collection andanalysis. These strategies challenge theadvanced practice nursing student to applyresearch concepts to problems encountered inclinical practice and reinforces the skillsneeded to critique the literature, tosummarize the published findings on aproblem, to conceptualize a research study,and to disseminate their findings in oralpresentations.Search terms: Evidence-based nursingeducation, graduate nursing education,teaching advanced practice nurses research

Jill Hamilton, PhD, RN, is Assistant Professor at theUniversity of North Carolina at Chapel Hill.

The emphasis on educating advanced practice nurseswho are research literate and capable of integrating thebest evidence with clinical expertise challenges educa-tors to implement strategies to ensure that researchcourses adequately prepare them to assume these roles.However, current strategies to teach research have notemphasized application of concepts, leading nursingstudents to question the relevance of this subject toclinical practice (Burke et al., 2005).

One aspect of evidence-based nursing education isthe application of the research process (Emerson &Records, 2008). For advanced practice nurses, thisapproach includes application of the concepts relatedto qualitative and quantitative methods of inquiry tofind and use the best evidence to promote optimalpatient care in clinical practice areas. According toCiliska (2005), the process of achieving evidence-basednursing practice involves a series of successive steps:(a) identifying a clinical problem; (b) searching theliterature for reviews and critical appraisals of relevantresearch; (c) creating change(s) in practice that is basedon the specific evidence, including patient needs, andexpertise of the advanced practice nurse; and (d) evalu-ating implemented changes for effectiveness. Nursingstudents are accustomed to acquiring clinical skillsthrough a succession of progressive, logical steps inwhich they learn to manipulate the patient environ-ment for improved clinical outcomes. Therefore, it islogical that acquiring skills to design and manipulatethe patient environment for clinical research alsorequires a series of progressive steps (Webber, 2008).

Advanced practice nursing students are required topractice evidence-based nursing; yet, it is not clearwhether current teaching strategies prepare them tomeet these expectations. Publications addressingteaching research to nursing students are concentratedon introducing undergraduate nursing students to spe-

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cific research experiences in ongoing projects (Newton,McKenna, Gilmour, & Fawcett, 2010); however, thereare no publications detailing strategies that encompassthe conceptualization of a research project. A review ofthe literature and the experiences of the first authorwith evidence-based nursing education indicateseveral barriers to teaching research in graduate-levelnursing programs. One barrier is that nursing studentsare not literate when it comes to the research processand in reading and evaluating research articles (Smith-Strom & Nortvedt, 2008). Another barrier is that gradu-ate nursing research courses are typically taught inisolation from clinical courses (Burke et al., 2005), andthis separation likely reduces the value that graduatestudents place on research and its relevance toevidence-based practice. In addition, the design ofgraduate nursing research courses may not emphasizeapplication of research concepts or the usefulness ofthese concepts in solving clinical problems (Burkeet al., 2005). Moreover, traditional approaches at teach-ing the research process in classrooms in which theinstructor lectures and students are “notetakers”promote passive learning with students retaining littleof the content covered (Oermann, 2004).

A review of strategies used to teach research innursing education suggests several approaches. First,

among undergraduate students, some strategies haveincluded pairing students with clinical nursingresearchers (Kennel, Burns, & Horn, 2009), writing aone-page significance paragraph using data andrelated literature (Ross & Markle, 2009), and joiningjournal clubs (Steenbeek et al., 2009). Second, amonggraduate nursing students, suggested strategiesinclude exercises to critique the research literatureand to develop clinical protocols based on the find-ings generated from research (Burke et al., 2005); thisstrategy entailed having students pose a question,discuss their literature search strategy, critique aselected number of articles, and use the findings fromthese articles to change some aspect of their clinicalpractice (Burke et al., 2005). From all strategiesdescribed above, major outcomes are that studentsbecome research literate, understand the relevance ofresearch to clinical practice, and are capable of trans-lating concepts of the research process to changes inclinical practice for the benefit of an individual clientor a clinical population.

In this paper, we describe our efforts to engagegraduate nursing students in learning about researchand its use in evidence-based practice. The overall goalfor graduate nursing students is to promote advancedliterature search skills and critical appraisal ofboth qualitative and quantitative research articles, todevelop theory-based practice guidelines or researchproposals based on a critical review of the literature,and to apply concepts of the research process to clinicalissues in clinical practice.

Overview of Graduate-Level NursingResearch Course

Students in the graduate nursing research coursecomplete four learning activities that culminate in afinal research/clinical application project at the end ofthe semester. The projects are based on clinical prob-lems of the students’ choosing, and the students formwork groups that consist of two to four peers withsimilar clinical interests.

Nursing students are accustomed to

acquiring clinical skills through a

succession of progressive, logical steps in

which they learn to manipulate the patient

environment for improved clinical

outcomes.

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The primary teaching strategies for the courseconsist of faculty-led discussions, peer-led group dis-cussions, and in-class group presentations. Prior toeach class, course faculty posts lecture notes prior tothe class on Blackboard (an online academic program)and so reserves in-class time for discussions on con-cepts and the application of these concepts to researchprojects and clinical guidelines. Peer-led group discus-sion forums are set up on Blackboard for students tocommunicate with their peers on issues related to theirprojects and to elicit feedback from faculty. In-classgroup presentations are conducted by studentsfocused on how the research process was used toanswer their clinical questions. This teaching strategyallows students to develop the skills of disseminatingtheir ideas and to also elicit feedback from peers andfaculty. Students may elect to post their PowerPointpresentations prior to a given deadline for feedbackfrom faculty on content and style, and they are encour-aged to use resources available to them as they developtheir projects. For example, the health sciences librar-ian is useful for advanced search techniques. In addi-tion, school of nursing faculty with expertise on aparticular clinical or research problem may be used asconsultants.

Clinically Based Research Projects

The first assignment begins the conceptual phase ofthe research process (Polit & Beck, 2008) and focuseson reviewing the literature, assessing the state ofscience on a clinical topic, and formulating researchquestions and/or hypotheses. In the first assignment,the students decide on a clinical problem to address.They are directed to search research databases andlocate peer-reviewed or systematic review articlesrelated to a clinical problem. Using these articles, thestudents are to identify the study design, the sample,setting, variables measured in the study, and majorfindings of the study. The students also summarizethe articles and identify the gaps and omissions basedon the findings. Finally, based on the findings from

these articles, students revise their initial problemstatements and preliminarily decide whether aresearch project or clinical guideline will be the finalproject.

In assignment number one, the students will havedeveloped a written problem statement, purpose state-ment, a research question, and a hypothesis or both.Students then use PowerPoint to present their ideas fora research study to the class. Over the course of thesemester, students receive in-class time to meet as agroup to discuss their projects. During the semester,also, they can use discussion groups on Blackboard foradditional communication needs. Faculty members areavailable for in-person meetings with the groups priorto any presentations to give feedback and offer sugges-tions, and answer questions.

In assignment two, the conceptual phase continuesas students begin to identify a theoretical frameworkwith potential utility in guiding their research or clini-cal application project. Under faculty guidance, stu-dents identify frameworks used in peer-reviewedresearch articles or other sources. Students select atheory or model, and discuss the originator of thetheory, the purpose of the theory with an explanationof why a particular theoretical framework or modelwas chosen, and the operationalization of and relation-ship among concepts in the chosen theory or model. Insome instances, students have reviewed scientific lit-erature that is atheoretical. In this situation, facultydirects students to resources and assists them to locatea middle-range nursing theory that can be utilizedwith their projects. Once a theory or model is selected,students examine the relevancy of a particular theoryor model to their patient or clinical population, andmake revisions. Given their expertise and resources,students then select from theories or models those con-cepts that are relevant and modifiable for patient out-comes. A final component of assignment number twois that students examine the values and assumptions oftheir chosen framework.

In the third assignment, using the clinical problemidentified in assignment number one, students concep-

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tualize what they will do to implement a change inoutcomes with a clinical patient population. The inter-ventions or clinical guidelines described by studentsare guided by the theories or models selected inassignment number two, which are also appropriate tothe previously stated problem and purpose statement.Finally, the interventions or clinical guidelines areexpected to advance scientific knowledge or clinicalpractice, consider underserved patient populations,and consider the knowledge level, training, and exper-tise as advanced practice nurses. After students com-plete assignments two and three, they make theirsecond in-class presentation.

In the third assignment, using the clinical

problem identified in assignment number

one, students conceptualize what they will

do to implement a change in outcomes

with a clinical patient population.

Assignment four, the design and planning phase(Polit & Beck, 2008), focuses on (a) the selection of aresearch design; (b) identification of a study popula-tion; (c) details of procedures for implementation ofprojects or guidelines; and (d) plans for data collection,specifying measures to evaluate research variables,addressing threats to validity, and evaluating outcomeand feasibility issues. In this fourth assignment, stu-dents initially make decisions on approaches to studydesigns. Students become aware that while random-ized controlled trials may be the “gold standard,” thisresearch design is not always feasible or necessary inmaking small-scale changes within clinical popula-tions. In assignment number four, students think

through inclusion and exclusion criteria, decide howthey will recruit subjects if needed, and determinewhether their proposed intervention or clinical guide-lines are appropriate for their clinical population. Stu-dents consider threats to statistical conclusion validity,internal validity, and external validity. They also iden-tify strategies they will implement to minimize thosethreats and consider ways in which outcomes will beevaluated. Finally, as with previous assignments, stu-dents continue to consider underserved populationsand feasibility issues in the development of theirprojects.

The final group project, a compilation of the researchcompetencies addressed in the previous four assign-ments, also includes a discussion of relevant ethicalissues. This final project, an in-class activity scheduledat the end of the semester, is in the format of a formalscientific research presentation. For example, coursefaculty develops brochures featuring the students andtheir projects. Students dress for the occasion andinvite other peers and colleagues who have providedconsultation to their projects throughout the semester.And, at the end of the scientific sessions, refreshmentsare served, and students are encouraged to give con-structive feedback to their peers.

In the early development phases of the course, thestudents’ course grade came solely from faculty evalu-ation of the group projects. However, in response toincreasing class sizes and the increasing enrollment ofstudents with varied experiences with researchcourses, faculty has incorporated points from class par-ticipation and from quizzes that are administered uponcompletion of each module. The inclusion of thequizzes after each module has been especially usefulwith the early identification of those students who maybe struggling with the concepts being taught in thecourse. Faculty is then able to offer extra tutoring tothese “low performing” students to help them be suc-cessful in the class. The points from class participationand the quizzes count for a minimal amount of thecourse grade so students are not penalized for lack ofprevious exposure to research.

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Student Outcomes and Feedback

Students have consistently reported that the coursewas helpful and enlightening in regard to the processof nursing research and especially with application ofresearch concepts to clinical problems. At the end ofthe semester and on completion of their group researchor clinical guidelines projects, students indicate thatthey are confident in their abilities to identify andrevise clinical problems, and to conduct literaturesearches in which they review research related to clini-cal topics while critically appraising the research rel-evant to clinical topics. In addition, they developstrategies for change in practice that are sensitive to thepatient needs and feasible, given the expertise of andresources available to the advanced practice nurse.Although students are not engaged in the empiricalphase of actual data collection and data analysis, theyhave gained an introduction to the knowledge neededto engage in these activities. Former students havereported that they have continued some aspect of theirprojects in clinical settings as advanced practice nurses.In addition, former students have reported that thecontent of the course enhanced their ability to readresearch articles. For example, one student stated thatbefore the class, she would only read the conclusionsection of research articles because she did not possessthe skills to understand the other sections. However, asa result of the knowledge acquired from this class, shewas now able to read research articles in their entiretyand understand the study design and sampling strat-egies. Students who enrolled in doctoral programs ofnursing have reported that this class gave them a foun-dation for their continued nursing education.

Finally, a valuable learning activity was garneredthrough the group presentations in class. An importantcomponent of the research process is dissemination offindings, and this is often in the form of presentationsat scientific sessions (Burns & Grove, 2009). From thisexperience, students learned to communicate orallytheir research ideas to defend questions related to theirprojects among their peers. A formal presentation of

the research project using PowerPoint and othervisuals is often the first step in collecting useful feed-back, suggestions, and comments prior to preparationof a manuscript. Although former students have ben-efited from inviting their colleagues and other facultyto the presentations, expanding those invitations tonurses from the clinical areas would encourage the useof the ideas generated from the projects into practice.

Although former students have benefited

from inviting their colleagues and other

faculty to the presentations, expanding

those invitations to nurses from the clinical

areas would encourage the use of the ideas

generated from the projects into practice.

Positive feedback from former students includedskills obtained from the peer group discussions andfrom group work on the projects. For example, stu-dents commented that they developed analytical skillsuseful in other graduate courses and had the opportu-nity to interact with diverse classmates, which was avaluable part of the learning experience. Students com-mented that the group projects assisted in their abilityto apply the concepts and not just memorize them.

A consistent and negative comment from the stu-dents is that typically one or two members of the groupdo most of the group work, and it is possible to havestudents with minimal contributions still receive thegroup grade. Attempts to minimize this problem haveprompted the use of peer evaluations and the restric-tion of group members to a maximum of four students.However, the problem of inequities in group grading

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appears to be ongoing, and the author is consideringalternate strategies for assessing group work(Oermann & Gaberson, 2009).

Conclusion

The teaching strategy presented in this report chal-lenges graduate nursing students to apply researchconcepts to problems encountered in their clinicalpractice. This approach promotes the skill to critiquean existing base of knowledge for the purpose of plan-ning a research study or clinical guidelines project.Specifically, students are challenged to review existingliterature related to a clinical problem or question, tosummarize the findings, to conceptualize a researchstudy or clinical guidelines project, and to disseminatefindings in an oral presentation. Further, in collabora-tion with their peers and content experts, students areencouraged to consider vulnerable and medicallyunderserved populations, and to evaluate cost–benefitissues related to development of strategies to promotechange related to a clinical problem or question. Theemphasis on educating advanced practice nurses whoare well equipped to use the best evidence in promot-ing optimal patient care in clinical areas calls for con-tinued discourse of teaching strategies. This teachingstrategy takes us one step further toward that goal.

Future directions would be to examine the benefit ofthis teaching strategy to students conducting thesisprojects as part of their graduate education. Presently,final class presentations are attended primarily bynursing faculty. However, opening the presentations toclinical nurses could be of benefit in developing col-laborative relationships so that ideas from the stu-dents’ projects are transferred into practice.

Author contact: jhamilto@email.unc.edu, with a copy to theEditor: nursingforum@gmail.com

References

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Burns, N., & Grove, S. K. (2009). The practice of nursing research:Appraisal, synthesis, and generation of evidence (6th ed.). St. Louis,MO: Saunders Elsevier.

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Kennel, S., Burns, S., & Horn, H. (2009). Stimulating student interestin nursing research: A program pairing students with practicingclinician researchers. Journal of Nursing Education, 48(4), 209–212.

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Steenbeek, A., Edgecombe, N., Durling, J., LeBlanc, A., Anderson, R.,& Bainbridge, R. (2009). Using an interactive journal club toenhance nursing research knowledge acquisition, appraisal, andapplication. International Journal of Nursing Education Scholarship,6(1), 1–8.

Webber, P. B. (2008). The doctor of nursing practice degree andresearch: Are we making an epistemological mistake? Journal ofNursing Education, 47(10), 466–472.

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