Giving nursing students effective feedback is tricky! It is a skill that has been identified by the Faculty of Nursing at the University of Calgary as requiring added support for their new instructors.
There is a lack of online courses teaching this skill specifically to nursing instructors. Giving Feedback has been identified as an essential skill for providing formative assessment to nursing students (Burgess, et al., 2020; Plakht et al., 2013). Constructive feedback is tricky to define and to teach. It is a delicate balance that requires the instructor to gain the trust of the student, not be too negative, nor too positive, not be general, nor too specific, remain non-judgmental, and provide the feedback in a way that does not make the student fear making mistakes again (Cantillon & Sargeant, 2008; Stephen et al., 2020; Plakht et al., 2013). It is a delicate balance and it is easy to see why it has been identified as an area requiring more support.
This activity is designed to be interactive with both in-course questions and branching scenarios to illustrate possible outcomes with different styles of feedback. We used the BEER method of feedback as the most effective feedback delivery in a clinical nursing setting. We contrasted this with the sandwich method, which was previously thought to be effective for feedback.
The Canadian Association of Schools of Nursing Clinical Instructor Certification course (Raby, 2022) has identified the BEER method as the most efficient feedback delivery tool. In a clinical nursing situation, it is the method that is clear, direct, empathetic and does not discourage the student from learning from their mistakes. Our activity describes and models this method for new nursing instructors in situations which are likely to occur in a clinical teaching setting.
The University of Calgary Nursing program has several satellite locations, the online nature of this training makes it accessible from all sites. It can also be accessed on traditional computers, tablets or phones, removing some of the barriers to access.
Try out a sampling of what the course could look like, and then imagine it with real actors and videographers and additional branching scenarios and questions.
We used H5P branching scenario video (H5P Group, 2013) to develop this training because of its interactive nature, it’s ability to be hosted by different platforms and because it’s modular. The interactivity makes the learning more engaging for our students (nursing instructors) and the branching scenarios allow us to create typical and realistic situations. It can be hosted on WordPress sites or on several LMS platforms. It can also be integrated into the LMS for assessment. The modular nature of it makes it easy to change different parts of the training should new regulations or other changes occur.
To develop this activity further, more examples of different typical scenarios could be included with both good and poor outcomes to illustrate how to strengthen the instructors’ skills in giving feedback. The knowledge of experienced instructors could guide which scenarios would be included in an expanded training program. Involving current instructors in the building process would expand their digital literacy along with the literacy of new instructors taking the course.
Supporting Literature
Stephen et al. (2020) write that learning without fear, creating trust and psychologically safe situations leads to better outcomes. Participants did better at learning tasks when knowing what to expect. This type of training would prepare nursing instructors with language and ideas to handle many different types of situations. This experience would fit with Kolb’s (2014) Experiential Learning Theory that has be espoused by much of the education community. The reflective observation phase identified by Kolb encourages students to intentionally reflect on their experience from multiple perspectives (Poore et al., 2014) This would allow instructors to reflect before moving on to other aspects of experiential learning. The article by White et al. (2021) found that increased instruction in debriefing, or giving feedback, led to more positive results in teaching the skill: “…nurse educators need to be provided with opportunities to practice and develop the skills of giving good feedback, which ties in with best practice guidelines.” There is a lot written about the importance of giving good feedback but not many demonstrations of how to do it well.
The Canadian Association of Schools of Nursing Clinical Instructor Certification course (Raby, 2022) has identified the BEER method as the most efficient feedback delivery tool. In a clinical nursing situation, it is the method that is clear, direct, empathetic and does not discourage the student from learning from their mistakes. Our activity describes and models this method for new nursing instructors in situations which are likely to occur in a clinical teaching setting.
References
Burgess, A., van Diggele, C., Roberts, C. et al. Feedback in the clinical setting. BMC Med Educ 20 (Suppl 2), 460 (2020). https://doi.org/10.1186/s12909-020-02280-5
Cantillon, P. & Sargeant, J. (2008). Giving feedback in clinical settings. BMJ, 337(nov10 2), a1961–a1961. https://doi.org/10.1136/bmj.a1961
H5P Group. (2013, June 10). H5P Interactive video. H5P. Retrieved October 25, 2022, from https://h5p.org/branching-scenario
Kolb, D. (2014). Experiential Learning: Experience as the Source of Learning and Development, Second Edition (2nd edition). PH Professional Business.
Plakht, Y., Shiyovich, A., Nusbaum, L., & Raizer, H. (2013). The association of positive and negative feedback with clinical performance, self-evaluation and practice contribution of nursing students. Nurse Education Today, 33(10), 1264–1268. https://doi.org/10.1016/j.nedt.2012.07.017
Poore, J.A., Cullen, D. L., & Schaar, G. L. (2014). Simulation-Based Interprofessional Education Guided by Kolb’s Experiential Learning Theory. Clinical Simulation in Nursing, 10(5), e241–e247. https://doi.org/10.1016/j.ecns.2014.01.004
Raby, M. (2022) Clinical Instructor Certification Course: Module Three [PowerPoint slides]. Canadian Association of Schools of Nursing.
Stephen, L., Kostovich, C., & O’Rourke, J. (2020). Psychological Safety in Simulation: Prelicensure Nursing Students’ Perceptions. Clinical Simulation in Nursing, 47, 25–31. https://doi.org/10.1016/j.ecns.2020.06.010
White, H., Hayes, C., Axisa, C., & Power, T. (2021). On the Other Side of Simulation: Evaluating Faculty Debriefing Styles. Clinical Simulation in Nursing, 61, 96–106. https://doi.org/10.1016/j.ecns.2021.08.004