1. Monsivais, Diane B. PhD, RN, CNE
  2. Robbins, Leslie K. PhD, APRN, PMHCNS/NP-BC, FAAN

Article Content

In 2014, graduate nursing students in our online program identified group work as a high priority area for program improvement. Students had been assigned to work in small groups of typically 3 to 5 students each to complete an assignment. The most frequent reasons for dissatisfaction were related to group members who did not do their share of work and perceived difficulties with communication when members had different work schedules.


However, despite the drawbacks identified by students, there are beneficial aspects to having students work in groups. Group assignments allow students to create final products that are more complex (and potentially useful) than can be accomplished by an individual student and also engage them in collaboration. Students need to develop collaborative skills, and employers expect that graduates are able to easily work in teams. Because of the compelling reasons in favor of group work, we wanted to learn how to use this type of assignment more effectively in our classes.


Our School of Nursing had approximately 300 graduate students enrolled at the time of the survey. Most students work full time and have family obligations. The courses are set up in 7-week blocks, with students taking 1 course each for 7 weeks on a year-round basis. The courses are fast paced, emphasizing the need for easily accessible resources and smooth processes for students to concentrate on the course content instead of course logistics.


Evidence-based Education

Evidence-based education consists of both using evidence to guide teaching practices and generating new evidence through research.1 The evidence was clear that our teaching practices related to group work needed improvement. We developed a quality improvement (QI) plan using the evidence-based education process proposed by Emerson and Records.2 The process parallels the evidence-based practice framework used in the clinical setting but uses wording adapted for the educational setting. For example, when creating a question to focus a literature search, instead of the clinically focused terms of "patient, intervention, comparison and outcome," the terms are educationally focused: "student/problem, teaching strategy, comparison, and outcome." Rather than provider expertise, the focus is on faculty expertise.


When applied to our situation, the education question was the following:


Student/problem: graduate students in an online master of science in nursing (MSN) program


Teaching strategy: strategies for group work assignments that facilitate successful learning and improved student satisfaction


Comparison: current practice


Outcomes: successful learning outcomes and improved student satisfaction with group work activities



Therefore, in narrative form, the education question was: "For graduate students in an online MSN program, what are strategies for using group work that facilitate successful learning and increase satisfaction with the process?"


After formulating the question, we consulted our Health Sciences librarian who assisted with setting up a search strategy (databases, search terms, and inclusion and exclusion criteria). We decided on an integrative review using the framework of Whittemore and Knafl3 to provide an opportunity to use a full range of evidence including empirical, theoretical, and expert opinions.


Reviewing the Evidence for Applicability to our Setting

Whether in practice or education, multiple types of evidence should be taken into consideration to make optimal decisions.1,4-6 Evidence about the experience of the faculty, resources available, and student preferences should be considered. Just as provider expertise is often central to effective use of evidence in practice, faculty expertise is often central to effective use of an evidence-based education framework. Expertise with teaching strategies, specific pertinent information about the program and students, knowledge of available resources, and understanding the program and system combine to shape every step of the process from identifying the question to evaluating the change. Without adequate faculty expertise, not all the evidence will be known and taken into consideration.


Education Evidence Interaction Framework Applied to Group Work Problem

We conceptualized the complex interaction of factors that create successful learning outcomes using the Education Evidence Interaction Framework (see Figure, Supplemental Digital Content 1, Faculty expertise provides the ability to critique multiple types of evidence for applicability to a specific setting and is at the central core of the framework. Faculty in the graduate program ranged from novice to experienced educators. Identifying the relevance of the evidence and applicability to our situation was an important component of the appraisal. In many of the articles reviewed, author opinion was often merged with study results in the discussion sections of the articles, making distinction between the two difficult. However, based on educator expertise with the situation, we could determine relevance and applicability to our situation.


An example is a group contract found during the review. Because it was developed for undergraduate students in a face-to-face course in a traditional 15-week format, it was not easily usable with our students. Therefore, the contract was provided as a resource, and students were advised to review the items orally with each other instead of filling out the form and submitting it to faculty for review. Simply bringing issues such as preferred communication and negotiating tasks to the forefront of conversation early in the group process proved helpful in giving students a starting point for their group work.


Experienced faculty can assist novice faculty evaluate the appropriateness of assignments for group work, as well as ensure faculty are including available school and university resources to facilitate group work processes and online education. The next part of the model, understanding student preferences, allowed us to proactively address preferences for individual work instead of group assignments during our onsite orientation for new students. One of the activities is a small group work to complete an exercise in writing synthesis, which is set up to allow everyone to be successful with the exercise. After the exercise, students are reminded that they participated in group work, and it was a positive experience. They also are reassured that they will be provided with guidelines for working together and communication tools (such as dedicated discussion boards and audio collaboration areas). According to student feedback, meeting classmates in person facilitates online group work during the program. In addition, we know to set expectations at the beginning of a course by emphasizing how a specific assignment will benefit from group work and the overall reasons for including group work in the course. Although some of the assignments, such as creating a class plan as part of a teaching team, lend themselves easily to group projects, the reasons for making it a group project still should be emphasized in the assignment directions.



Results of a survey alerted us to the need to improve teaching practices related to group work assignments. We used an evidence-based education process to guide our QI plan and the Education Evidence Interaction Framework to help refine how we would apply the evidence we found. Setting expectations, providing guidelines for working together, and adding specific communication tools for each group to the course have increased student satisfaction with the process. Group projects are used as an exemplar in this article; however, the process is applicable to any educational situation in which QI is needed.




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