Collaborative practice in a nursing research course

Interdisciplinary evidence-based practice (EBP) is a key component of quality patient care. As a result, there have been repeated calls for nurses and nursing students to develop the skills needed to effectively implement interdisciplinary EBP (American Association of Colleges of Nursing [AACN], 2021; National Academy of Sciences, National Academy of Engineering, & Institute of Medicine, 2005; Newhouse & Spring, 2010). These skills include continually analyzing new research and translating it into nursing practice as well as generating interdisciplinary knowledge through collaborative research (Malik et al., 2016; Newhouse & Spring, 2010). However, fostering these skills can be difficult (Li et al., 2022; Verloo et al., 2017). The main reason for this is that nursing-related research courses involve abstract concepts that nursing students struggle to learn and connect to their future practice (Chanda, 2019; Schug et al., 2018). As a result, nursing students tend to possess negative perceptions about their research-related courses and may even fear them, which can negatively impact their ability to engage with and benefit from course content (Hagen et al., 2013). In addition, opportunities to observe and develop collaborative research skills tend to be limited in nursing curricula (Hermann et al., 2016). For these reasons, it is imperative that nurse educators develop additional strategies for supporting nursing students in developing their professional identity as interdisciplinary evidence-based practitioners (Stevens, 2013). To address this need, two nursing faculty collaborated with a colleague from their university's mathematics department to implement a class project to role model interdisciplinary practice and help students learn research-related concepts. Faculty hypothesized that students would enjoy the experiential learning strategy and have improved confidence in participating in research.

The Great Cookie Experiment (GCE), first introduced by Thiel (1987), is an experiential teaching strategy developed to engage nursing students in their research-related courses, which can promote EBP. Thiel had students engage in a mock research study comparing chocolate chip cookies with varying amounts of cholesterol. Students took on both the role of researcher and study participant in this classroom activity. Thiel's survey comparing cookies, the Cookie Assessment Tool (CAT), had flaws with the Likert scale descriptors which was used as an impetus for dialogue (Morrison-Beedy & Côté-Arsenault, 2000). Using cookies to teach provides a nonthreatening and hands-on tool for learning about abstract research concepts (Kearney, 1988). The GCE has been shown to be an effective learning strategy (Hagle & Millenbruch, 2011; Tsai et al., 2014). Following participation in the GCE, students have shown improved knowledge (Lane et al., 2016; Tsai et al., 2014), and improved confidence (Sawatzky-Dickson & Clarke, 2008) related to their research coursework. Numerous studies have reported an increased willingness to participate in research (Tsai et al., 2014) and improvements in students’ course evaluations and grades (Schmitt et al., 2019) following the implementation of the GCE. The GCE has been used to successfully teach both qualitative and quantitative research concepts (Chanda, 2019) and has also been found to positively engage staff nurses in research concepts (Walden et al., 2015). Multiple versions of the GCE exist, and the most recent versions incorporate technological advances, such as clickers (McCurry, 2014), and collect data through mobile gaming platforms, such as Kahoot (Lane et al., 2016).

A modified GCE was created collaboratively and injected with intentional flaws to help nursing students become more comfortable with and knowledgeable about collaborative research. The simulated collaborative nursing research class activity through guided actionable steps of the research process was implemented with two cohorts of junior undergraduate nursing students. The first cohort was enrolled in the research course in the spring of 2022, and the second cohort was enrolled in the same course in the spring of 2023. Each spring, the research course was divided into two sections, and in 2022 and 2023 the first author taught one section while the third author taught the second section. In 2022, the first author taught this course for the first time and was interested in using the GCE to help their students learn about research. However, both nursing faculty were hesitant to implement the quantitative components, since both had a background in qualitative research. Understanding the need to collaborate with a colleague with experience in quantitative research, the nursing faculty realized this was an ideal opportunity to role model collaboration for their nursing students. Hence, four months before the start of the spring 2022 semester, they began collaborating with a statistician (second author) at their university to modify the GCE and implement it in their nursing course.

The modifications of the GCE were created collaboratively between the nursing and statistics faculty to enhance learning through the expertise of both quantitative and qualitative researchers. The diverse knowledge and skills of the researchers provided greater depth in the design of the curriculum and served as an exemplar of interdisciplinary collaboration. First, GCE lessons were revised to include intentional design flaws (see Table 1). These flaws were used as jumping-off points to teach the course's research concepts. Second, the student survey (i.e., CAT) developed for this project was modified from previous GCE surveys (Hagle & Millenbruch, 2011; Morrison-Beedy & Côté-Arsenault, 2000; Thiel, 1987; Walden et al., 2015) and can be seen in Table 2. The modified CAT collected demographic, quantitative, and qualitative data. Modifications to the CAT survey from the original Thiel (1987) survey included removing texture as a variable from the cookie assessment and changing the descriptive categories of the Likert scale. Additionally, some demographic information from Walden et al.’s (2015) survey was modified and expanded on, and a qualitative question was added to the survey similar to Morrison-Beedy and Côté-Arsenault (2000). These modifications were made to employ a mixed-method approach and to include flaws in the survey design as a teaching strategy. Lastly, the curriculum that was developed by Thiel (1987) and updated by Walden et al. (2015) was expanded in greater detail over three classes that included opportunities for all three faculty to lead interactive discussions and class activities with the students. The collaborative design of the GCE strengthened the class activity.

The GCE was modified and implemented in a nursing research course for two consecutive years during the spring semester. Each semester, 64 third-year undergraduate students were enrolled in the research course and participated in the GCE. However, of the 128 students, only 109 students completed the CAT due to class absences and allergies to the ingredients in the cookies, therefore some students could not taste or handle the cookies.

Initially each semester, the GCE was conducted over three regularly scheduled classes toward the end of each term. The GCE was implemented separately for each section of the course. Next, both of the nursing faculty implemented the experiential simulated study on the first day of the GCE and then individually taught their respective section how to qualitatively analyze the data at the next class meeting. Lastly, the statistics faculty member delved into the quantitative analysis of the project on the last day. Following the end of the GCE, a debrief was conducted to make meaning of the students’ experiences. A detailed curriculum of research concepts was discussed over the course of the three GCE classes as seen in Table 3. All topics were discussed with some topics covered in multiple classes. In addition, there was an explicit discussion of the collaborative practice between the nursing and statistics faculty in designing and implementing the GCE and how that collaborative approach could be translated into the nursing students’ future practice.

During the first GCE class, the data collection component of the simulated study occurred. Both nursing faculty came to both course sections to describe and implement the GCE. Students were given a sample consent form stating the potential benefits and risks of participating in the GCE and the steps taken to protect human subjects. The consent form was used as a teaching tool to talk about the process of acquiring informed consent and the different elements of the form. Before the first GCE class, the two nursing faculty baked their own favorite chocolate chip cookie recipe. One faculty member's cookies were labeled Cookie A, and the other faculty member's cookies were labeled Cookie B. A nursing student, not enrolled in the target research course, served one Cookie A and one Cookie B to each student in each research section. Cookie A was packaged differently than Cookie B. To enhance the appearance of Cookie A, it was wrapped in a cellophane wrapper and ribbon with a sticker stating, “Made with Love, Cookie A.” Cookie B was wrapped in a decorative Ziplock bag with glitter stickers. To prevent the students from mixing up the cookies, the cookies were placed on a sheet of paper labeled Cookie A and Cookie B with a line running horizontally through it. Before students compared the cookies, the research questions of the simulated study were discussed. The research questions of the simulated study were: Do nursing students prefer Professor A's cookies or Professor B's cookies? Do nursing students prefer the texture (moistness) of Professor A's cookies or Professor B's cookies? Do nursing students prefer the flavor of Professor A's cookies or Professor B's cookies? The faculty hypothesized that the preferred cookie would have a moist texture with a richer chocolate flavor.

As an intentional flaw to the GCE (and used as a teaching point), the nursing faculty encouraged students to pick their course faculty's cookie with the offer to give higher grades and letters of recommendation. Although the students did not know which professor baked which cookie, students had several hypotheses. Participants were encouraged to rinse their mouths with water before tasting the second cookie to prevent treatment carryover; however, water was not provided. After students tasted both cookies, they filled out the CAT in Microsoft Forms. An interactive lecture was presented after the study to discuss elements of a research study. Topics of this discussion are presented in Table 3. Results were analyzed qualitatively and quantitatively and reviewed in class over two class periods.

The second GCE class consisted of analyzing qualitative data from the CAT, regarding the students’ experiences eating Cookies A and B. Nursing faculty began class with an interactive class discussion around qualitative research. Next, the students took on the role of researcher and analyzed the qualitative data. A printed summary of all of the statements was provided to students. A modified Colaizzi's (1978) method of data analysis was utilized. Students read the statements and obtained a general sense of the lived experiences of their classmates regarding eating the two cookies. Students worked in small, self-selected groups to identify significant statements and articulate what the statements meant. The formulated meanings were clustered and put into themes via classroom discussion. The themes identified included cookie texture, cookie appearance, cookie aroma, cookie flavor, homemade, and the affective experience of having a cookie. Next, the nursing faculty worked with the students to integrate all the resulting ideas into an exhaustive description of the experience of eating the two cookies. Exemplary statements were identified. Lastly, during the classroom discussion, the themes were reviewed, and students were asked to confirm the qualitative findings.

During the third GCE class, the statistics faculty member facilitated a classroom discussion of the analysis process and interpretation of the GCE quantitative data. Because of time constraints, the statistics faculty member analyzed the quantitative data from the CAT before the third class. An engaging discussion of the different phases of quantitative research and relevant topics (see Table 3) ensued. The survey design was reviewed, and the injected flaws were highlighted. Some questions had low variability that highlighted the homogeneity of the group on certain variables, such as age. Additionally, various software programs and statistical approaches that can be used for quantitative data analysis were described. Further, the instructor led a class discussion on how to input, clean, and store data as well as handle missing data.

Descriptive statistics were utilized for most of the quantitative analysis of the CAT data utilizing Microsoft Forms. Inferential statistics using R software was used (R Project, 2023), which led to a discussion about taking the results from the GCE study and generalizing them to a larger population. The results of the statistical analysis of the GCE data were compared to the hypotheses, and statistical inferences were made for the different research questions posed by the GCE. A Z-test and confidence intervals were used to examine whether nursing students preferred Professor A's cookies or Professor B's cookies. Paired t-tests and confidence intervals were utilized to assess if there was a statistically significant difference in the mean score for cookies A and B relating to flavor, appearance, and moistness. The statistics faculty member discussed the results of the logistic regression in terms of whether individual variables, such as moisture, flavor, appearance, GPA, exercise, age, and living on campus were associated with choosing cookie A or B. The results supported the hypothesis that the students preferred the cookie that was moist with a richer chocolate flavor.

Following the quantitative discussion, the winner of the GCE was announced, and a trophy was awarded to the winning baker. Faculty observed students’ enjoyment of the competitive aspect of the GCE.

After the end of the GCE activity, the nursing faculty debriefed the students about their experiences. The debriefing process is a critical component that allows students to gain a clearer understanding of content with the goal to identify and resolve gaps in knowledge, skills, attitudes, and communication-related to the individual, team, and/or system. The goal of the debriefing process is to assist in the development of insights, improve future performance, and promote the transfer and integration of learning into practice. (INACSL Standards Committee et al., 2021, p. 27)

During the 2022 debriefing activities, informal feedback about the GCE was gathered from students. This feedback was very positive toward the GCE teaching strategy, and students said that it helped them to better understand the course's research concepts. The following year, a formal evaluation survey was developed and implemented using Microsoft Forms. Fifty-two of the 64 students enrolled in both sections of the nursing research course completed this five-question survey. Three questions utilized a five-point Likert scale and asked the following: (a) whether the simulation helped the students better understand the research process, (b) whether the GCE experience helped the students feel more confident about engaging in research, and (c) whether students believed the GCE was an effective teaching strategy. The remaining two questions were open-response items that asked the students what they learned about collaboration from participating in the GCE.

Of the 81% who completed the postactivity survey, anecdotal evidence was very positive. Feedback elicited from the survey showed that most students recognized the value a collaborative approach to research plays in nursing practice and had an improved understanding of the components of research. Students were more confident after completing the GCE and believed that the modified GCE was an effective learning strategy. Some of the qualitative comments discussed when you have a good team and the right tools, research does not have to be a scary concept. Students shared that the GCE was a fun activity to learn research. Student comments about what they had learned about research can be divided into two categories; they either commented on a holistic understanding of the research process or spoke on specific topics related to improved knowledge attainment. Some specific aspects that were discussed about conducting research were the importance of removing bias, proper survey development, and cleaning quantitative data for analysis. The faculty enjoyed this class activity because they could see the students' engagement and understanding of the research topics. Overall, students and faculty enjoyed the collaborative GCE learning activity.

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