Teaching research to undergraduate community nursing students: reflections upon curriculum design

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  • Teaching research toundergraduate communitynursing students: reflectionsupon curriculum designSue Peckover and Susan Winterburn

    Despite the widespread inclusion of research education within nursing courses, there remaina number of tensions about the purpose, content, and philosophy underpinning suchprogrammes. Of particular concern is the importance of establishing appropriate teaching

    and learning strategies in order to ensure that research education is enjoyable andeffective. These issues are explored within this paper, and provide the background context

    for this discussion on the redesigning of a research module within an undergraduateprogramme for post-registration community nursing students. The paper highlights the

    rationale for undertaking this change, and discusses the educational frameworks,which were used in order to develop the programme. An initial evaluation

    suggests the redesigned curriculum is a positive development that has enhancedboth the teaching and learning of research.c 2003 Elsevier Science Ltd. All rights reserved.

    Introduction

    The drive towards evidence-based nursing(Department of Health 1999), which requiresnurses to have the skills and knowledgeto both understand and use research findingswithin their practice, has obviouseducational implications. Although this partlyexplains the considerable expansion ofresearch within nursing curricula, this hasalso developed as a response toprofessionalisation and the repositioning ofnursing within higher education.However a number of tensions concerning thepurpose, content, and educational strategies ofresearch courses have been identified (Clark &Sleep 1991; Perkins 1992; Lacey 1996; Dyson1997; Parahoo 1999; Tetley & Glover 1999;Mulhall et al. 2000). As Dyson (1997) pointsout,

    . . .mere inclusion into a curriculum is notadequate and nurse educators mustaddress the teaching and learningstrategies that they adopt in order to makeresearch education more effective (Dyson1997, p. 611).

    This paper describes the process ofredesigning an undergraduate researchmodule for post-registration communitynursing students. This arose because thelecturers involved in teaching the moduleidentified a need for greater clarity interms of the purpose of the course, as well asrecognising the need to address theteaching and learning strategies within theprogramme. The process of undertaking thiscurriculum review is described following adiscussion of the literature relating to thistopic.

    104 Nurse Education in Practice (2003) 3, 104111 1471-5953/03/$ - see front matterc 2003 Elsevier Science Ltd. All rights reserved.doi:10.1016/S1471-5953(02)00078-1

    Article

    Sue PeckoverPhD, PGCEd RGN,RHV, LecturerSchool of Nursingand Midwifery,University ofSheffield, SamuelFox House,Northern GeneralHospital, HerriesRoad, Sheffield S57AU, UKTel.: +44-114-2714068;fax: +44-114-2714944; E-mail:S.Peckover@Sheffield.ac.uk

    Susan WinterburnM Med Sci, CertEd RGN RHV,Senior NursingLecturerSchool of Nursingand Midwifery,University ofSheffield, SamuelFox House,Northern GeneralHospital, HerriesRoad, Sheffield S57AU, UKE-mail:S.A.Winterburn@Sheffield.ac.uk

    (Requests foroffprints to SP)

    Manuscriptaccepted:30 July 2002

  • Research education withinnursing curricula: a review ofthe literature

    There is a lack of clarity about the purpose andcontent of research programmes withinundergraduate nursing curricula. Manywriters suggest that the purpose of teachingresearch is to equip nurses with the skills andknowledge necessary to undertakeevidence-based practice (Hunt 1987; Lacey1996; Dyson 1997; Taylor & Muncer 2000),while others emphasise the development ofresearch literacy (Moule et al. 1998; Tetley &Glover 1999). In describing the requirements ofa diploma level course, Burrows and Baillie(1997) focus upon research awareness andunderstanding as well as . . .the ability to usethis to enhance the quality of care delivered tothe client (Burrows & Baillie 1997). In contrast,Reed (1995) argues that research is includedwithin nursing curricula as a consequence ofthe integration of nursing within highereducation, suggesting that one of the purposesof teaching research is to enable students to. . .develop understandings of the academicworld of which they will be members(Reed 1995).While the need to promote evidence-based

    practice provides the rationale for muchresearch education at both pre-registration andundergraduate level, there are considerabledifferences in how this is achieved (Overfield& Duffy 1984; Clark & Sleep 1991). Overfieldand Duffy (1984) identify three approaches tohelping students learn about research,described as learning by critique, learning byproposing to do, and learning by doing.Similarly Clark and Sleep (1991) suggest thatthere are two main approaches described as. . .facilitating an awareness of research withthe aim of increasing the use of researchfindings in practice and learning by doing(Clark & Sleep 1991). These differences arereflected in the wide variations in content ofundergraduate research courses.

    The level at which students learn aboutresearch varies across centres with someacademic courses focusing on developingskills in critiquing research andconsideration of the application to practice

    whilst others take students through thefull experience of proposing anddeveloping a project. Although for manyundergraduate courses, the notion ofdeveloping a research proposal equateswith diploma level studies whilstundertaking data collection and analysisfits with degree level and above, such aninterpretation is not consistent (Clifford1997, p. 119).

    Differences in the content of research coursescan be illustrated by examining differentaccounts of research education (Lacey 1996;Reed 1995; Burrows & Baillie 1997; Tetley &Glover 1999; Mulhall et al. 2000; Taylor &Muncer 2000; Ax & Kincade 2001). Lacey(1996), for example, describes an educationalprocess in which students themselves engagein data collection and analysis. While this isjustified in terms of learning by doing, withcourse evaluations suggesting that studentsfound this an enjoyable aspect of the course,there is no discussion of the rationale forincluding this within an introductoryundergraduate course. A similar approach on apre-registration nursing programme isreported by Ax and Kincade (2001), althoughinterestingly the authors describe this course interms of research training.In their discussion of the research

    component of a pre-registration nursingcurricula, Tetley and Glover (1999) clearlyidentify the purpose in terms of thedevelopment of research literacy skills,describing an educational strategyunderpinned by experiential learning andreflection. Burrows and Baillie (1997) highlightthe use of research presentations and journalclubs as teaching strategies designed to enablediploma level students to develop a criticalawareness of research processes and itsapplication in clinical practice. Moule et al.(1998) discuss the use of a poster presentationfor the teaching and assessing of research forboth pre- and post-registration nursingcourses, suggesting that this provides aframework for the development of researchliteracy skills as well as transferable ones suchas teamwork, communication, information use,and presentation skills. In contrast, Reed (1995)describes an undergraduate research module

    Teaching research to undergraduate community nursing students

    c 2003 Elsevier Science Ltd. All rights reserved. Nurse Education in Practice (2003) 3, 104111 105

  • for qualified nurses, which uses a groupresearch project to enable students activeexploration of each stage of the researchprocess. This provides a supportedopportunity for students to undertake researchand engage in the decision making skillsimplicit within a research project. It alsoprovides a framework for learning aboutcritical appraisal, using an approach thatemphasises the development of skills andknowledge about research processes.The differences in course content reflect

    different curriculum models, highlightingparticularly the tensions between product- andprocess-based curricula (Tyler 1949; Stenhouse1975; Sheehan 1986). In simple terms,product-based courses have a more directionalemphasis upon the educational outcome of theprogramme, whereas process-based coursesemphasise the learning that takes place duringthe educational programme. Such inherenttensions are particularly problematic given thenature of research. Although a reasonablestarting point may be represented by thequestion what is it that nurses need to know inrelation to research?, this is particularlydifficult to answer given the subject matter. Forexample, research does not represent a subjectin itself, but arises from a broad range ofdisciplines such as sociology, psychology, andmedicine. There is a wide range of knowledgeassociated with research ranging fromunderstanding processes and approaches, tophilosophical debates concerning the nature ofknowledge and ethics. Similarly the skillsrequired for research are vast and includereading, finding and using information,synthesising and analysing, as well as writingand presentation. In the context of clinicalnursing practice, the application and utilisationof research involves wider considerationsincluding organisational and managementissues. Taken overall this suggests thatestablishing the purpose and content ofresearch curricula within undergraduatenursing education is complex. Even thoughcourses may have a clear purpose, such asteaching students to undertake evidence-basedpractice, or to critically review publishedresearch, the educational considerations inrelation to how this may be achieved leads toinherent tensions between product- and

    process-based curriculum models (Tyler 1949;Stenhouse 1975; Sheehan 1986).Research education needs to be enjoyable

    and interesting in order for students to developpositive attitudes towards research (Clark &Sleep 1991; Burrows & Baillie 1997; Dyson1997; Tetley & Glover 1999). However, as Axand Kincade (2001) demonstrate this is notalways achieved. Obviously this may be for anumber of reasons, but as Tetley and Glover(1999) point out, the abilities, interests,previous experiences, and learning styles of thestudents themselves must be considered whenplanning and implementing researcheducation.The role of nurse educators is widely

    discussed, with a number of writershighlighting a need to improve strategies forteaching research (Perkins 1992; Clifford 1997;Dyson 1997). Implicit within these arguments,however, is a critical perspective about theresearch capabilities of nurse teachers. Lacey(1996), for example, in an evaluation of anundergraduate research course (ENB 870),reveals that . . .nurse teachers who undertookthe course report that they are being used asresource people for research teaching to Project2000 students (Lacey 1996, p. 300), thussuggesting there is a low level of research skillsand experience amongst nurse educators. Thisis further explored by Clifford (1997) whoreports the results of a survey into the researchrole of nurse teachers. Although the findingsare based upon returned questionnaires from124 teachers working in 4 English nurseeducational institutions, they highlight theirlimited research activity and poor overallpreparation for their developing researcheducation role. Despite the lack of more recentresearch in this area, the continued emergenceof research capability in nursing as evidencedby the 2001 Research Assessment Exercise(HEFCE 2001) suggests this picture might bechanging.There is limited literature focusing upon the

    evaluation of research education (Lacey 1996;Dyson 1997; Morris 1999; Parahoo 1999;Mulhall et al. 2000). Lacey (1996), for example,reports a short term evaluation of a researchcourse highlighting the positive impact this hasfor practitioners in terms of their utilisation ofresearch in clinical practice. An evaluation

    Teaching research to undergraduate community nursing students

    106 Nurse Education in Practice (2003) 3, 104111 c 2003 Elsevier Science Ltd. All rights reserved.

  • undertaken by Dyson (1997) focussed uponstudent enjoyment and the development ofpositive attitudes towards research, whileMulhall et al. (2000) also examined theeffectiveness of courses in increasing the skillsof critical appraisal. However as Parahoo(1999) points out, there has been little attemptto link research utilisation with researcheducation or to evaluate the effectiveness ofresearch education within nursing. Although adiscussion of these issues is beyond the scopeof this review, it does highlight some of thecomplexities, particularly the diversity ofpurpose and content of research education,within nursing curricula.

    Reviewing the research module

    Our experience of reviewing researcheducation within nursing curricula arose fromour involvement in teaching a module inresearch methods as part of an undergraduateprogramme preparing students as SpecialistCommunity Nurses. Although one of us hadbeen involved in teaching this module for 4years, they had not been instrumental in itsoriginal development, while the other was anewcomer to the teaching team but hadpersonal experience of learning about researchin a student-led educational environment(Rogers 1983). The difficulties we identifiedwith the module included the teacher ledapproach, the lack of clarity about purpose andthe emphasis upon theory rather thanapplication. Previous student evaluationsreflected these concerns, as well as clearlyindicating a lack of enjoyment of this module.The driving impetus for this review, however,arose from the process of course revalidationwhich this programme was facing at the time,and which often represents the organisationaland professional context for curriculumre-development.In reviewing the research module, the

    framework suggested by Quinns descriptionof curricula as . . .a plan or design foreducation and training that addresses thefollowing questions, who?. . . what?. . . why?. . .how?. . . where?. . . when? (Quinn 1994, citedin Quinn 2000, p. 133) was utilised. This meantthat the first issue to consider was the students

    who would be taught. There are usually 3540students undertaking the module, and beyondthe sharing of a common professionalbackground as qualified nurses, these studentsare considerably diverse, in relation to age,educational background, academic ability,geographical location, and professionalexperience. The majority are part-time maturestudents, often with family as well as workcommitments. Moreover, although theprogramme prepares the students forcommunity specialist practice, this is alsomarked by considerable diversity in terms ofclient group, clinical activity, andorganisational context. For example a largenumber of students undertaking the courseworked within occupational health, andalthough this is an area of communityspecialist practice it is very different to primaryand community care where the majority of thestudents worked.The next important issues relate to the

    purpose and content of the curriculum,expressed...

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